Case 181: Manual of PCI - Atherectomy for STEMI

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A patient presented with inferior STEMI. Emergency coronary angiography showed 100% mid occlusion of the mid right coronary artery. Wiring was challenging but eventually succeeded using a Fielder XT wire. The lesion was balloon uncrossable. Eventually it was crossed with a Sapphire 1.0 mm balloon but no other balloon would cross, despite using a guide extension and doing grenadoplasty (intentional balloon rupture in the mid RCA). Orbital atherectomy was subsequently performed allowing balloon crossing and lesion expansion but there was distal embolization requiring aspiration with the Penumbra Cat Rx catheter. A nice final result was achieved.
Category
Cardiology
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