66yo 3d post surgery bowel CA. CP + NSTEMI + EF 35%, posterior Scar. Decision LAD Stent. Expansion with NC 24 atm. Unlucky.... #PCICase @kaschenke @a_Klumb @naderjo @rvprog @agikinterv @SukhNijjer @agtruesdell @ajaykirtane @SVRaoMD @evandrofilhobr @jedicath @djc795 @HadyLichaaMD

BP drop To 70. Severe pain, restless, trying to stand up. O2 99%. @sbrugaletta @DLBHATTMD @BaoGTran @trivaxheartmd @jason_wollmuth @Hragy @ShariqShamimMD @mirvatalasnag @HolgerNef @Drroxmehran @mmamas1973
@DrAsifQasim @ALEX_MISCHIE @Babar_Basir @rwyeh @agtruesdell
@KPujdak

What would you do next? @sabeedak1 @aayshacader @fabioccarvalho @calvinphang
@SVRaoMD @fischman_david @DocSavageTJU @lorenzo2509 @KAlaswadMD @adnannadir @DrAmirKaki @ShariqShamimMD @RajTayalMD @djc795 @DavidLBrownMD @SripalBangalore @adityadoc1 @ISeropianMD @KardiologieHH

RCA Diagnostic

LCA diagnostic

Spider Diagnostic

Stent 3.0 x 33mm, suboptimal expanded due to Ca++

PostStenting: NC 3.0 x 6 mm needed to go up to 24 atm for full expansion. No burst but then Perforation, Typ III. See above

Decided for quick ballooning of the perforation 3.0 x 15mm, then intubation. Echo 3-4 mm circular, no tap needed. BP after fluid, noradrenalin low dose 70-80 mmHg. How long do you inflate?

After 20 min.

Now, is there still need of a covered stent? Echo is unchanged. No drain needed

Had a long discussion about the next step. So we put a 3.0 x 15 Papyrus distal of D1. We left D1 like this and will do second look/PCI in a few weeks. Final angio. Extubated 2 Hours later. Puuuh...