Case 135: PCI Manual - Wiring challenges

An elderly woman presented with unstable angina and was found to have 2-vessel coronary artery disease with severe lesions in the LAD and the circumflex. PCI of the circumflex bifurcation lesion was successfully performed using the provisional technique. The LAD lesion was highly tortuous and calcified. Attempts to advance a workhorse guidewire through the LAD failed. Repeat attempts with a Sion black guidewire caused dissection with decreased antegrade flow. A Stingray balloon was used to re-enter into the distal true lumen using the “double blind stick and swap technique”. Stenting restored flow into the LAD but resulted in side branch occlusion (septal and diagonal) with persistent chest pain and cardiac biomarker elevation.

[@ahmedelsokary7076]

very nice case

[@farukakturk5388]

Thank you very much for this educative presentation.

[@shangz0216]

Thanks for the educative presentation.

[@bilalwazzaz9820]

Thank you

[@rajmaster0]

before balloon angioplasty how did you confirm you were in true lumen..?

[@Kulseref]

Dear dr. Brilakis, if we do not have stingray catheter, what we can do (except CABG)? Thank you

[@manosbrilakis]

You could try using a microcatheter (ideally a dual lumen microcatheter) and various guidewires including stiff tip guidewires (such as Hornet 14 and Confianza Pro 12) to enter into the distal true lumen. You could also use IVUS to determine the wire location.