How to treat main vessel coronary perforation: step-by-step

Step-by-step description of what to do when main vessel perforation occurs during coronary interventions.

[@salahuddinsalahuddin3210]

Nice presentation. Thanks.

[@marceloribeiro897]

Nowadays we have the Biotronic PK Papyrus covered stent which is not as bulky as this one... We tend to reverse heparin ( only half), and keep flushing the guide catheter several times per minute. It is much more common the perforation to be caused by the high pressure inflation itself, especially by an eccentric calcium in the plaque, without rupturing the balloon. This facilitates the proximal inflation of the balloon faster then the operator could do in your example. Probably by just reversing half the heparin you could have achieved hemostasis in this case, but we never know, if you have the covered stent and believes it can be delivered , go for it. But if you did use the covered stent there is no need to reverse anticoagulation. Never forget it will always be a fight between thrombosis and haemorrhage when a perforation occurs.

[@fh677]

Thank you

[@farukakturk5388]

I am watching your presentations with pleasure. Honestly ı learned a lot of things from you. Recently ı had a huge rupture at LAD and sealed it with graftmaster 4.0x19 mm covered stent. What is your strategy for further antiagregation of these kind of patients? I am following my patient wit 300 mg ASA and 10 mg prasugrel. Would you do so or am ı unnecessarily taking risk of bleeding?

[@saraskathiresan]

Excellent presentation

[@chicosuave9]

Thank you for these how to videos. Which software do you use to do these screen capture videos?

[@manosbrilakis]

camtasia

[@manosbrilakis]

Camtasia

[@KillerWhale806]

what a badass

[@micger]

The perforation is proximal to the stent. Did you inflate and rupture the balloon in an unstented vessel?

[@matthewpincus1681]

where's the lesion?

[@neazmakhdum7691]

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