8th Experts Live CTO Workshop 2016, September, 30th - October 1st, 2016 in Krakow, Poland

1. Complication: How to Manage
Peiman Jamshidi MD FESC
Director of Invasive Cardiology
Lucerne Heart Center
Lucerne Switzerland

2. A 48 years old man
 ACS (Non-STEMI)
At the presentation day symptomfree
Physical Examination: Normal
cvRF: Positive FH; Hyperlypidemia, Smoking
Coronarangography: 3VD, CTO of the LCX and
the totally occluded RCA, probabely recently
EF 47%

3. Decide to do CABG or PCI?

5. The patient reject the CABG
• PCI of the RCA was done at the first
session

8. 5 days later PCI of the LAD bifurcation with
Diagonal branch was done with mini crusch
and kissing balloon technique
• After Kissing balloon in the LAD and the
Diagonal branch…………….

14. What has happened?
• Stent under depoyment?
• Balloon under deflation?
• Balloon ruprure?
• Balloon tearing
• Stent was lost in LM?

15. What is the next stepp?
• Snare the balloon?
• Snare the Stent?
• Pull the balloon and the stent vigorouly to
tear the balloon?
• Call the surgeon?

16. What should do the surgeon
• 1-Cut the balloon and the stent
• 2-Do Bypass only
• 3-Both 1 and 2
• 4-Take the Stent out from the LM

17. The Surgery
• The surgeon cut the stent and balloon in the
ostium of the LM and do LIMA to the LAD
and SVG to the Marginalbranch
• Max CK-MB 32mmol/l (normal <5)

18. What is the next step?
• Wait and watch
• Try to snare the stent from the LM
• Try to post dilate the stent in the LAD
and in the LM
• Try to Stent the LAD and the LM
again

23. Final Result

24. Outcome
• The patient was disacharged with a very
good condition after 10 days
• The EF before discharge 50%
• 3months later, the patient was
asymptomatic

25. Take home massage
• Be carefull of balloon ruprutre during kissing
balloon
• If you can not pull the balloon back, puncture the
other side and put another Guiding catheter and
wire with balloon to save the vessel
• Try to pull back the balloon a little bit vigorously
if it dose not work call the surgeon

26. Thank you for your attention