Case 292: Manual of CTO PCI - Complicated Side BASE

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A patient was referred for PCI of a right coronary artery CTO. The CTO had a blunt but well-defined proximal cap just distal to the takeoff of an acute marginal branch, length of approximately 20-30 mm, diffusely diseased distal vessel and both septal and epicardial collaterals. Antegrade wiring and retrograde crossing attempts failed. The side BASE technique was performed inflating a 2.0 mm balloon that allowed advancement of a knuckled Gladius Mongo to the mid RCA. Re-entry was achieved using the Stingray balloon. The patient became hypotensive with pulsus paradoxus. Coronary angiography of the CTO vessel showed a perforation of the acute marginal branch. After inflating a balloon in the RCA we performed pericardiocentesis and placed a PK Papyrus successfully sealing the perforation. A DES was deployed inside the PK Papyrus stent.
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Cardiology
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