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COMPLICATION

PERCUTANEOUS CORONARY INTERVENTION

Yusra Pintaningrum
Faculty of Medicine, Mataram University – RSUD Provinsi NTB
Fellowship Interventional Cardiology – RSUD Dr Soetomo Surabaya

Background
• PCI may be challenging and complicated
• Improvements in devices, the use of stents, and
aggressive antiplatelet therapy have significantly
reduced the incidence of major periprocedural
complications of PCI over the past 15 to 20 years
• The need for emergent CABG decreased in two series:
from 1.5 % in 1992  0.14% in 2000
from 2.9% in 1979 to 1994  0.3% in 2000 to 2003

Joseph, 2016

EDUCATIONAL CONTENT ENDORSED BY EAPCI,
A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY

The New York State PCI registry 1999-2006

© 2016 Europa Digital & Publishing. All rights reserved.
The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine
The prevention and management of complications during percutaneous coronary intervention
Rodney De Palma, Christian Roguelov, Adel Aminian, Olivier Muller, Tito Kabir, Eric Eeckhout

EDUCATIONAL CONTENT ENDORSED BY EAPCI. Olivier Muller. A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY Periprocedural complications within 24 hours © 2016 Europa Digital & Publishing. Adel Aminian. Tito Kabir. All rights reserved. The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine The prevention and management of complications during percutaneous coronary intervention Rodney De Palma. Eric Eeckhout . Christian Roguelov.

Olivier Muller. All rights reserved. Tito Kabir. Eric Eeckhout . Christian Roguelov. A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY Broad Mechanisms that lead to complications © 2016 Europa Digital & Publishing. EDUCATIONAL CONTENT ENDORSED BY EAPCI. Adel Aminian. The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine The prevention and management of complications during percutaneous coronary intervention Rodney De Palma.

Complication PCI Patient preparation and selection During the procedure Vascular complications .

Patient Preparation and Selection Contrast reactions diabetes Left ventricular dysfunction and shock Acuity of presentation Renal insufficiency Peripheral vascular disease Anaemia .

stent dislodgement .During procedure Dissection and abrupt closure after PTCA perforation Distal embolization Complication seen with stenting • Stent thrombosis .

Vascular Complications Retroperitoneal bleeding Pseudoaneurisma AV fistula Infection Hematome dissection Lower extremity ischaemia .

Case 1 BALLOON DETACHMENT .

male • Hypertension (+) for 10 years • ECG : SR 85 bpm. anterior extensive old myocard infarction • CXR : CTR 65% . Case ilustration • A 57 year-old .

Coronary Angiography Old Stent Patent at proximal LAD Old Stent Patent At proximal LCX .

CTO at proximal-mid RCA .

1x10 mm ..0x9 mm distal to proximal RCA  balloon detachment . Anchor balloon CTO 2. Microcatheter finecross . Buddy wire to distal RCA .5x10 mm . Balloon Saphire 1.5x10 mm  balloon Mozec 2. Balloon Across CTO 1.0x15 mm  balloon Across CTO 1.5 x 15 mm to SN . Balloon Across CTO 1. GW Runthrough NS hypercoat .

Withdraw the two wires with the stent to the twisted end can trap the stent guiding catheter then the whole system . Capture Balloon Two wire technique Dislodged stent in the wire A second wire is advanced through the stent strut or beside the stent Twisting the two wire together.

Balloon Detachment .

FINAL RESULT Stent DES Ultimaster 2.5 x 33 mm No Residual Stenosis TIMI Flow 3 No Complication .75x33 mm Stent DES Ultimaster 2.

Case 2 STENT DISLODGEMENT .

. Illustration Case • Male 61 years old • stable angina • Comorbidities – Hypertension – dyslipidemia – heavy smoker. • ECG : inferior old myocardial infarction.

Stenosis 60% distal LM Stenosis 70% osteal LCX CTO distal LCX Diffuse disease LAD .

Diffuse disease Subtotal stenosis mid RCA .

0x 36 mm  stent dislodgement Stent DES Firebird II . GC JR 4.5x15 mm Stent BMS Apollo 3.0 6F GW pilot 60 Balloon Saphirre II 1.

.

Stent dislodgement “Small balloon technique” .

.

FINAL RESULT Stent BMS Arthos PICO 3.0x34 mm Stent DES Firebird II .

773 PCI cases (January 1994 and March 2004) – Stent loss : 38 (0. Stent Dislodgement / stent loss • The incidence : 3.4% (earlier)  0. 95% CI = 0.32% (recent) • 11.66(3):333-40.32%. . 2005 Nov.23-0.44%).40:405-409 Catheter Cardiovasc Interv. Korean Circ J 2010. • Successful stent retrieval : 35 • Stent loss occurred more frequently in lesions with calcification and/or significant proximal angulation.

com/device-loss-during-percutaneous-coronary-intervention-incidence-complications-and-retrieval-methods/ . Garratt http://thoracickey. MECHANISM STENT LOSS Brilakis.

gov) . inflating the balloon. 2005 Nov. How to retrieve the stent loss? according successful stent retrieval (%) advancing a balloon through the stent.66(3):333-40 (PubMed. and withdrawing the loop snare (26%) biliary forceps (12%) stent (45%) Cook retained fragment twirling two wires basket retrieval device (2%) retriever (10%) around the stent (5%) Catheter Cardiovasc Interv.

com/device-loss-during-percutaneous-coronary-intervention-incidence-complications-and-retrieval-methods/ . Homemade snare GW exchange 300 mm Diagnostic Catheter 4-5 Fr (usually multipurpose) Brilakis. Garratt http://thoracickey.

How to anticipate the complication of PCI? .

Tito Kabir. Adel Aminian. The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine The prevention and management of complications during percutaneous coronary intervention Rodney De Palma. EDUCATIONAL CONTENT ENDORSED BY EAPCI. Eric Eeckhout . Christian Roguelov. Olivier Muller. All rights reserved. A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY Risk stratification tools using combination of patient and lesion characteristics © 2016 Europa Digital & Publishing.

Tito Kabir. Olivier Muller. EDUCATIONAL CONTENT ENDORSED BY EAPCI. The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine The prevention and management of complications during percutaneous coronary intervention Rodney De Palma. Eric Eeckhout . Adel Aminian. A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY Complication ‘Tool-Box’ © 2016 Europa Digital & Publishing. Christian Roguelov. All rights reserved.

Christian Roguelov. All rights reserved. EDUCATIONAL CONTENT ENDORSED BY EAPCI. The PCR-EAPCI Textbook – Percutaneous interventional cardiovascular medicine The prevention and management of complications during percutaneous coronary intervention Rodney De Palma. Eric Eeckhout . Adel Aminian. A REGISTERED BRANCH OF THE EUROPEAN SOCIETY OF CARDIOLOGY Schema for illustrating the risk of complications associated with a procedure © 2016 Europa Digital & Publishing. Tito Kabir. Olivier Muller.

1% and minor 7 % • The risk of complication relating procedure: Patient-equipment-operators related factors • Attention to prevention. Conclusion • Periprocedural complications within 24 hours : major 4. recognition and treatment of these complications is essential .

An intervensionist can be called expert after dealing with complicated cases of PCI and cases of PCI with complications .

• THANK YOU .