Description of Event or Problem · 1
ANGIOGRAPHIC REPORT: REPEAT ANGIOGRAPHY REVEALED WHAT APPEARED TO BE A LINEAR DISSECTION IN THE DIAGONAL BRANCH. WITH A 3.0 X 15 MM BALLOON IN THE LEFT ANTERIOR DESCENDING, A 2.25 X 15 MM MINIVISION STENT WAS PLACED IN THE DIAGONAL BRANCH AND DEPLOYED AT 10 ATMOSPHERES WITH SIMULTANEOUS INFLATION OF THE BALLOON IN THE LEFT ANTERIOR DESCENDING. KISSING BALLOON ANGIOPLASTY WAS PERFORMED USING A 2.5 MM BALLOON IN THE DIAGONAL AND A 3.0 X 15 MM BALLOON IN THE LEFT ANTERIOR DESCENDING TO 8 ATMOSPHERES. REPEAT ANGIOGRAPHY AT THIS POINT REVEALED GOOD STENT EXPANSION IN BOTH THE LEFT ANTERIOR DESCENDING AND THE DIAGONAL. THE GUIDE WIRE WAS REMOVED FROM THE LEFT ANTERIOR DESCENDING. ATTEMPTS TO REMOVE THE GUIDE WIRE FROM THE DIAGONAL RESULTED IN THE PT2 MS GUIDE TIP BEING ENTANGLED IN THE DISTAL END OF THE DIAGONAL STENT AND ATTEMPTS TO REMOVE THIS WERE UNSUCCESSFUL. ATTEMPTS TO DISLODGE THE WIRE TIP USING A 2.0 X 15 MM BALLOON AND A 1.5 X 15 MM BALLOON WERE UNSUCCESSFUL. A GUIDELINER WAS ALSO TRIED AND ATTEMPTS WITH THE BALLOON TO PUSH THE WIRE OFF THE DISTAL END OF THE STENT WERE UNSUCCESSFUL. WITH A 1.5 MM BALLOON IN THE DIAGONAL BRANCH TO THE TIP OF THE GUIDE WIRE, THE WIRE WAS PULLED RESULTING IN LEAD TIP FRACTURE. THE REMAINING GUIDE WIRE AND THE 1.5 MM BALLOON WERE REMOVED. ATTEMPTS TO WIRE THE LEFT ANTERIOR DESCENDING USING A WIRE WERE UNSUCCESSFUL. A HIGH-TORQUE FLOPPY WIRE WAS PASSED SUCCESSFULLY DUE TO THE STENT IN THE LEFT ANTERIOR DESCENDING INTO THE DISTAL VESSEL. THE LEFT ANTERIOR DESCENDING WAS DILATED USING A 1.5 X 15 MM BALLOON TO 8 ATMOSPHERES AT 2.0 X 15 MMBALLOON TO 14 ATMOSPHERES AND A 3.0 MM BALLOON TO 16 ATMOSPHERES. A 3.0 X 12 MM VISION STENT WAS THEN INSERTED, BUT WOULD NOT PASS. THE PROXIMAL LEFT ANTERIOR DESCENDING WAS AGAIN DILATED USING A 3.0 X 15 MM BALLOON TO 12 ATMOSPHERES. A 3.0 X 12 MM VISION BARE METAL STENT WAS THEN PLACED PROXIMALLY AND DEPLOYED AT 11 ATMOSPHERES POST DILATED USING A 3.0 X 15 MM BALLOON TO 18 ATMOSPHERES. ATTEMPTS TO REWIRE THE DIAGONAL BRANCH USING A HI-TORQUE FLOPPY WERE UNSUCCESSFUL. THE DIAGONAL BRANCH WAS REWIRED USING A PT2 MS GUIDE WIRE. THE DIAGONAL BRANCH WAS DILATED USING A 1.5 X 15 MM BALLOON TO 16 ATMOSPHERES AND A 2.5 X 15 MM BALLOON TO 12 ATMOSPHERES. PT GUIDE WIRE WAS THEN REMOVED FROM THE DIAGONAL. A REPEAT ANGIOGRAPHY AT THIS POINT REVEALED WHAT APPEARED TO BE GOOD FLOW IN THE DIAGONAL. THERE WAS A SHORT SEGMENT OF THE PROXIMAL LEFT ANTERIOR DESCENDING WHICH APPEARED TO BE UNCOVERED. THIS WAS STENTED USING A 3.0 X 8 MM BARE METAL STENT DEPLOYED AT 10 ATMOSPHERES AND POST DILATED USING A 3.0 X 15 MM BALLOON TO 14 ATMOSPHERES. REPEAT ANGIOGRAPHY AT THIS POINT DEMONSTRATED WHAT APPEARED TO BE WIDELY PATENT STENTS IN THE LEFT ANTERIOR DESCENDING WITH GOOD FLOW INTO THE LEFT ANTERIOR DESCENDING. THE STENTS IN THE DIAGONAL ARE FULLY DEPLOYED WITH RESIDUAL WIRE TIP FROM THE PT2 GUIDE WIRE TOWARDS THE DISTAL END OF THE STENT WHICH APPEARED TO BE IMMOBILE. WITH GOOD FLOW INTO BOTH VESSELS AND WITH THE AMOUNT OF DYE USED, THE DECISION WAS MADE TO COMPLETE THE PROCEDURE AT THIS POINT. LIMITED RIGHT FEMORAL ANGIOGRAPHY DEMONSTRATED GOOD SHEATH PLACEMENT. THE SHEATH WAS REMOVED AND THE WOUND WAS CLOSED.