Case 176: Manual of CTO PCI - Everything in moderation

[@tom11298]

Everything in moderation is essential in CTO and non-CTO lesions for example in STEMI patients who have dyspnea on the table and possible pre-Pulmonary edema, key is to avoid multi-vessel PCI in this emergency settings and focus on the culprit with minimal contrast use to avoid critical pulmonary edema that can have bad outcomes especially if the LV function is severely depressed.

[@georgetouma5430]

Manos great case! - we keep the concerto coils (large size) on shelf with a rebar or progreat microcatheter. Its exaxtly the same coil as the axium except they are not 0.014 and have fibrin strands. Only problem is you need to keep a progreat or rebar catheter and block and deliver requires 7F. Thrombin via a microcatheter and the blocking balloon to minimise back flow is a very good alternative in these cases as it will seal the perforation but allow repeat intervention in the future. Just a thought

[@shangz0216]

Thanks for the excellent case presentation.

[@ahmedrashedbasyouny5665]

Too much lessons to learn .... Very interesting case

[@svijaykumarreddy1242]

Good teaching points

[@dobryi_chel]

Great case! In my clinic Unfortunately we have not impella, but we have ECMO. Can we use ECMO in case like this?

[@farukakturk5388]

What is your final plan for RCA?