Case 131: PCI Manual - A great start!

A patient with 2-vessel coronary artery disease was referred for PCI of the right coronary artery and the LAD. The RCA had a significant ostial stenosis along with a 90% heavily calcified mid lesion with the PDA filling via collaterals from the LAD. During attempts for RCA PCI inadvertent contrast injection while the pressure was dampened resulted in extensive RCA dissection. The patient remained chest pain free without hemodynamic changes likely because of well-developed left to right collateral circulation. Attempts for reentry into the distal true lumen using a ReCross dual lumen microcatheter failed due to extensive subintimal hematoma. Retrograde crossing was successful but after wire externalization predilation and stenting there was no antegrade flow into the PDA and right posterolateral. Using a Mongo guidewire several passes were made into the PDA and right posterolateral restoring TIMI 3 antegrade flow without additional stent placement (STAR procedure).