Case 148: PCI Manual - Unexpected

A patient presented for staged PCI of a distal RCA lesion. However, the vessel was occluded upon engagement. The occlusion was successfully crossed with a Fielder XT-A wire through a Finecross microcatheter. After predilatation a distal vessel perforation occurred in the distal posterolateral. Embolization was done with a 2mm x 3 cm Axium coil using the “block and deliver technique”, but bleeding continued through the perforation. After embolization of fat hemostasis was achieved. Stenting into the PDA resulted in reduced flow into the right posterolateral that was treated with the reverse (also called internal) crush technique with a nice final result.