Case 150: PCI Manual - LIMA touchdown

A patient presented with angina after CABG and was found to have a 90% distal anastomotic lesion of the LIMA-LAD. An attempt to deliver stents failed and the patient was referred for a repeat attempt to stent the lesion of recanalize the native LAD CTO. Using a 7 French IM guide and a Caravel microcatheter we advanced a Minamo wire to the distal LAD and predilated with a 1.0 mm Sapphire balloon and a 2.0 mm balloon. The patient had slow flow down the IMA with chest pain and ECG changes. An initial attempt for DES delivery failed. Using the “independent hand technique” we were eventually able to deliver a 2.5x18 mm Orsiro to the LIMA-LAD anastomotic lesion and postdilated it with a 2.5 mm balloon. A nice final result with TIMI 3 flow was achieved after removing the LIMA guidewire.