Case 206: Manual of PCI - "Routine" NSTEMI

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A 76-year-old man presented with NSTEMI and was found to have severe, heavily calcified mid and ostial RCA lesions. The RCA was engaged with a 7 Fr AL1 guide through right radial access. The mid lesion was successfully predilated but 3 balloons ruptured when trying to dilate the proximal RCA lesion. The ostial lesion eventually expanded with a 3.0 mm NC non-compliant balloon. Angiography post predilatation showed a mid RCA dissection/perforation and an aorto-coronary dissection. We could not deliver a stent to the mid RCA but eventually we were successful using a 6 French Guideliner Coast, followed by deployment of another DES in the RCA ostium. Injection through the guide extension showed that the mid RCA had a dissection that was successfully treated. IVUS showed good stent expansion after postdilatation. The patient had an uneventful recovery.
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Cardiology
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