Case 95: PCI Manual - STEMI and unable to engage

A patient presented with inferior ST-segment elevation acute myocardial infarction. The left main was initially injected showing lesions in the LAD and circumflex. The RCA could not be engaged with a JR4 catheter. Cusp angiogram showed some filling of the RCA but the ostium could not be localized. Eventually the RCA was engaged with a multipurpose catheter: it had a superior and inferiorly directed take-off. Balloon angioplasty, followed by aspiration thrombectomy and stenting were performed with an excellent final result.

[@jontrembley8913]

I love this video so much. I see this video once or twice a month haha

[@salahuddinsalahuddin3210]

Thanks. Actually in my experiency I did have more low abnormal RCA take offs..

[@itsnerdbehaviour21]

Great real world case... thank you!

[@dr.hakanduman6004]

Thank you for your nice sharing.

[@alekstoreli3583]

excellent case. thank you. What guides do you prefer? I get better support with AL 2 guide in this kind of cases

[@afsanehmohammadi9226]

I have a similar case , thanks for tips

[@islammmi]

Thanks. Nice case. I Can see part of the thrombus is dislodged to the distal RCA before the crux.. Any plan for GP IIb. IIIa antagonist IC or IV?

[@ruotianli8785]

Could that sort of RCA also have been engaged by 3DRC guiding?

[@drgaganvelayudhan1733]

Did you have issues while tracking the thrombuster, stent etc? What would you suggest for more guide support.

[@randomshitplaylist]

Longer sheaths if coming from femoral access or guide extensions. In this case probably guide extensions given the way the catheter is sitting (if poor support).

[@harsh4082000]

were you concerned about the haziness at 6 30 PM on final picture angiogram? IVUS?