Complication Corner #1

An 82 year old lady suffering from severe aortic stenosis (Aortic Valve Area of 0.7cm2)  and stable angina classified as CCS grade 3, was referred to our catheterization lab for evaluation of coronary artery disease burden, as a prerequisite for potential Transcatheter Aortic Valve Implantation.  Two tight tandem stenoses in the mid and distal part of the Left Anterior Descending Artery were revealed.

 
 

What would your next step be?

Defer treatment and proceed with direct Trans-catheter aortic valve implantation.

FFR evaluation of tandem lesions and treatment on the basis of the established 0.8 cut-off value.

iFR evaluation of tandem lesions and treatment on the basis of the established 0.89 cut-off value.

Optimization of medical treatment and re-evaluation of symptoms.

A decision to carry out a PCI both in the distal and the mid part of the vessel was taken in the basis of FFR measurement which revealed a value of 0.61. After lesion preparation with a 2.5x20 semi-compliant balloon, a drug eluting stent (DES)(2.75x20) was delivered in the distal part and another DES (3x26) was delivered in the proximal part.

The injection following stent apposition revealed a Type III perforation in the distal edge of the proximal stent

 


What would your next step be?

Call the surgeon and anesthesiology department

Immediate balloon inflation in the area of perforation

Pericardiocentenis

Delivery of a Covered stent

All the above

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