Case 45: PCI Manual - When things don't go well

An elderly woman presented with NSTEMI due to a culprit lesion in the mid LAD immediately proximal to the bifurcation of a large diagonal branch. Attempts for wiring through the lesion resulted in acute vessel closure, resulting in hypotension and cardiac arrest. Patient was resuscitated and an IABP was placed. She also had aortocoronary dissection treated with left main stenting. The LAD was rewired and antegrade flow was restored. After stenting a perforation occurred at the distal edge of the stent. Delivery of a Graftmaster covered stent was extremely challenging due to calcification and diffuse disease, but eventually succeeded after changing to femoral access and inserting an 8 French Guideliner. The covered stent, however, likely subsequently occluded the large diagonal branch. The patient had a post-procedural myocardial infarction and subsquently died.