Complication: How to Manage

Peiman Jamshidi MD FESC

Director of Invasive Cardiology

Lucerne Heart Center

Lucerne Switzerland

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 andthe totally occluded RCA, probabely recently

EF 47%

Decide to do CABG or PCI?

The patient reject the CABG

• PCI of the RCA was done at the first

session

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…………….

What has happened?

• Stent under depoyment?

• Balloon under deflation?

• Balloon ruprure?

• Balloon tearing

• Stent was lost in LM?

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?

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

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)

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

Final Result

Outcome

• The patient was disacharged with a very

good condition after 10 days

• The EF before discharge 50%

• 3months later, the patient was

asymptomatic

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

Thank you for your attention