Case 182: Manual of PCI - LAD occlusion after stenting

[@shashijanjirala1402]

It takes a lot of guts and heart to put out basic but important cases in the video. Great teaching

[@matheuscsmed]

Thank you, Matheus Silva

[@tom11298]

Unfortunate case, thanks for the performing center to share this case with you. stent ideally should be implanted from healthy to healthy or ends (if no better landing zone) in plaque burden

[@Stentordoc]

I very much enjoy all of your videos, and I would be happy to see more of this type

[@RapshaD08123K]

I think the proximal landing zone had much plaque burden and thought there would be better to cover with another stent

[@user-tq2hd2dn5p]

2.5 mm stent is extremely undersized. You have the IVUS picture and angio… 3.5-4mm (and longer than 18) seems to be better choice

[@RapshaD08123K]

i'd choose 3,5 too

[@kathorhanes]

I dont know why ivus was done 😬 stent was undersized, too short, severly underexpanded - the result was poor both in angio and in ivus. Patients underoing routine angiography and pci are much more requiring than mi patients - the benefits of pci are under scrutiny and in this case we see why :(

[@shangz0216]

Thanks for the excellent case presentation.

[@nileshtawade3788]

Vasodilators should have been given through microcathter or thrombosuction catheter to increase the flow in microvascular bed

[@omegakimia]

Thank you for the great case sharing! Would like to ask after wiring through vessel closure & ballooning, can we do a repeat IVUS to confirm dissection then place another stent proximal to the 1st stent to close of the dissection? Instead of sending for CABG The flow might be better after stenting the dissection part

[@gaojingong2115]

I also think IVUS (preferably HD) should be performed to understand aetiology of the acute vessel closure when the patient was brought back to the lab (also safer than ballooning before confirming wire is in true lumen)..

[@ahmettemiz2528]

Thank you for this educative case. What about the result of surgery did he recover well

[@amrhanafymahmoud9829]

Excellent presentation for this case, but sir can I ask about mechanism of side branch closure as a cause for main vessel closure how can be done?

[@wilzboyz]

Anyone putting a 2.5 stent in a prox LAD should be sent to prison.

[@arpittomar5076]

Agree😂

[@indiechique2059]

We should appreciate the honesty at least. It’s a teaching point for all of us

[@haythamalkady9450]

I think microcatheter injection in distal vessel will help much by confirming true lumen and distal flow especially with dual injection from guiding can delineate occlusion site and size and go for stenting

[@jwilson3985]

Not a good idea. It will only worsen a hematoma and make grafting harder. Best way to confirm here is the see if the wire goes into diagonals or serials, or re IVUS. This would have been an easy bailout. Surgery was totally unnecessary.

[@jwilson3985]

I don’t have anything nice to say here. So I’ll stop. Thank you for sharing.