Case 133: Manual of PCI - SVG perforation

[@cdratik]

IS that a small air embolism inthe first shot of the filterwire?

[@tom11298]

Excellent educative points, undersized stents for SVG is a great point to keep in mind.

[@ahmedmed4811]

Was there air embolization in the cine after protection device insetion ?

[@dmx-spark]

i too feel that unless the perf causes a rapid tamponade and hemodynamic collapse its better to resort to covered stent directly,rather than spend time doing a balloon inflation to stop perf

[@denizaktürk-j7n]

Thank you for this brief for management of SVG perforarion. This was very educative and efficient for me.

[@ramidudin1]

Thank you for share this case, I think if IVUS done post stent inflammation, it could show stent over inflation more than 4.00 mm?.

[@svijaykumarreddy1242]

Very nice handling of SVG perforation

[@mohdiqbaldar881]

thanks a lot. all of ur cases are great learning. few points in this case. the first angio cine showed air embolism, air bubble going down the graft and OM. there is a wire like thing just parallel to OM (6:54), what is it?

[@shangz0216]

Thanks for the educative case sharing.

[@MohamedAhmed-wx9wk]

Great management. In general, i really don’t see a great advantage of this “ping pong “ technique. It is very short time to exchange a balloon for a covered stent and unlikely to cause significant hemodynamic instability. Also, why no one inflate a balloon on a buddy wire then deflate , retract the balloon to a single guide at the time of stent delivery?

[@LTzEz03z]

@3:40 The What? Technique?

[@zaidhakim]

Thanks for this case. Very informative. Do you think this was caused by oversizing the stent? My understanding is we normally go 0.5 mm less than what the IVUS tells us i.e. if 4 mm then u pick a 3.5 mm stent.

[@manosbrilakis]

Probably - choosing stent size depends on what you are measuring: if you are measuring distal lumen size you choose a stent that is 0.25 mm larger - if you are measuring "media to media" you downsize by 0.25 mm.