Case 20: PCI Manual: Heavily calcified right coronary artery

A patient with recent single vessel coronary bypass graft surgery (LIMA-LAD) underwent an unsuccessful attempt of PCI of a heavily calcified right coronary artery lesion. Using a combination of orbital atherectomy, multiple high-pressure balloon inflations, and Angioscuplt (delivered using the distal anchoring technique) the lesion was successfully dilated. Using the distal anchoring technique multiple stents were delivered and deployed with an excellent result, except for a distal small vessel perforation (likely to excessive guidewire movement during equipment delivery attempts). Using the "block and deliver" technique (balloon inflated proximal to the perforation to stop bleeding into the pericardium while a microcatheter is inserted distal to the inflated balloon and used to deliver fat or coils) the perforation was sealed. No pericardiocentesis was required. CT of the chest showed a small posterior loculated pericardial effusion.