coil embolization of perforation after transradial … kamishima.pdfintroduction •use of the trans...
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Coil embolization of perforation after transradial coronary intervention
Tokyo Women’s Medical UniversityDepartment of Cardiology
Kazuho Kamishima, Atsushi Takagi,Dai Okayama, Suguru Nakao, Hiroyuki Arashi, Norihiro Yamada,
Junichi Yamaguchi, Nobuhisa Hagiwara
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Introduction
• Use of the trans radial approach for PCI has increased in coronary angiography and intervention cases.
• Arterial perforation is a rare complication during the trans radial approach, occurring less in less than 1% of cases.
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Case72 y/o MaleDiagnosis) effort APClinical History)
1984 CABG(SVG-OM, LITA-LAD) in 1984,1991 re-CABG(GEA-LAD, SVG-#4AV) 2000 PCI to SVG-OM and distal RCA(#3) with BMS 2011 PCI to SVG-OM body with BMS(Integrity) 2012 ICD implantation2012 CRT-D up grade
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CAG(native coronary)
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LCA RCA
CAG(graft)
GEA-LAD SVG-OM
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PCI procedure
• CAG revealed restenosis of BMS in SVG.
• PCI was performed by transradial approach.
• We exchanged the 5Fr radial sheath for 6Fr.
• It was difficult to engage guide catheter to SVG. Thus we changed guide catheter 3 times. Finally, AL-2.0 was suitable. However, back up force of guide catheter was insufficient.
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PCI to SVG body
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Promus Element 3.5*12
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30min after PCI, patient complained pain
and…
Subclavian artery angiography
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Perforation
ITA
Subclavian A
Lateral
thoratic A
Selective injection pectral artery
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Procedure for artery embolization
• Despite compression of chest centered on bleeding site under fluoroscopic guidance, bleeding continued.
• Negative pressure with micro catheter was not effective, either.
• The decision was made to perform coil embolization.
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Coil embolization
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Figure 2.0/5 (Boston Scientific)× 3 Bleeding continued!
Fat emblization
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Take home message
• It is necessary to identify the tip of the guide wire during catheter exchange to avoid guide wire perforation of the side branch.
• Addition of fat embolization was effective when coil embolization was inadequate.
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