Complications of HSRA

1
Complications of HSRA

• Layth A. Mimish
• Consultant Cardiologist
• Cardiovascular Consultants Group
• Jeddah , Saudi Arabia

2
Slow/No Reflow

• 1.8-17
• Long lesions
• Heavy calcification
• Small vessels
• Long rotablation time
• Intra luminal filling defects

3
Slow/No Reflow

• Pre-treatment, peri-procedural
• Frequent flushing
• Short Burr time
• Flush solution
• Maintain coronary perfusion pressure, Inotropes
  /IABP

4
Coronary Dissection

• 12.8
• Burr size adjuvant PTCA
• Angiography
• IVUS
• Angioscopy
• Post mortem

5
Coronary Dissection

• Proper Burr size
• Control RPM
• Prolonged balloon inflation
• Atherectomy
• Stenting
• CABG

6
Coronary Perforation

• 0.6-0.7
• gtRCA Cx X LAD
• Eccentricity
• Tortuosity
• Lesion gt 10mm
• Guide wire Bias
• Total occlusion

7
Coronary Perforation

• Guiding catheter alignment
• Conservative
• Prolonged balloon inflation
• ? Stenting
• Graft stent
• CABG

8
Jostent Coronary Stent Graft
9
NACI Registry

• 525 patients, 670 lesions
• Death 0.5 ---------- 1
• Emergency CABG 0.4 -------1.4
• MI 6 (Non-Q 5) ---------3.4
• Dissection 12-15
• Side branch occlusion 3 ------7.5
• Distal embolization 3