Abstract
There is gratification in performing a high-risk intervention in a patient wary of general anesthesia, surgery, and a prolonged recovery (Figure 1-1). Unfortunately, this can be easily offset when an unexpected complication occurs during a seemingly straightforward intervention, necessitating additional and unplanned interventions to avert disaster (Figure 1–2). This is the reality of day-to-day percutaneous coronary interventions performed, on average, in 25% of patients undergoing diagnostic coronary angiography.
(A) Left coronary angiogram in left anterior oblique view. There is high risk and significant disease of the distal left main, proximal circumflex, and mid left anterior descending coronary arteries. (B) Right anterior oblique cranial view of same. (C) Left anterior oblique cranial view post proximal left anterior distal (LAD) stent implantation. (D) Predilatation of left main, circumflex. (E) Final angiogram after crush stenting in left main and kissing balloon angioplasty.
(A) Left coronary angiogram in the apical cranial view. High-grade disease is seen in the mid left anterior descending artery just distal to the origin of a diagonal branch. (B) Left anterior oblique cranial view with the intravascular ultrasonographic catheter at the lesion. A second wire is in the diagonal branch. (C) After balloon dilatation with a second, larger, cutting balloon, inadvertently oversized to the proximal vessel from intravascular ultrasound data, there is dissection of the LAD with reduced blood flow. (D) Additional unplanned stents were successfully placed with a good final angiographic result.
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Butman, S.M. (2005). Introduction. In: Butman, S.M. (eds) Complications of Percutaneous Coronary Interventions. Springer, New York, NY. https://doi.org/10.1007/978-0-387-29301-1_1
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DOI: https://doi.org/10.1007/978-0-387-29301-1_1
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