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Complications during percutaneous cardiovascular interventions

ESC Congress 2010

Dr Eeckhout introduced the session and defined the learning objectives, which were to analyse why complication may occur during percutaneous intervention and when and how it is possible to prevent complications by integrating complication cases with interactive discussion.

Dr A. Colombo, from Milan, presented the key points that should be kept in mind by interventionalists in order to minimize the occurrence of complication through appropriate selection of catheters, wires, balloons and stents, and appropriate and weighted decisions when some trouble comes up.

Dr Eeckhout presented a case with multivessel disease undergoing PCI. The procedure was complicated by stent mispositioning during deployment at the right coronary artery (RCA) ostium, protruding into the aorta dorsal long segment. He discussed with the Panel and the audience how to successfully manage this complication and he illustared how the stent could be snared and retrieved from the patient.

Dr Clemmensen showed a case with occlusive restensois on proximal RCA previously treated by brachytherapy, totally collateralized from the left coronary system. Clinical indications and procedural strategy were discussed. The procedure was complicated by dissection on proximal RCA involving the ascending aorta. How to proceed in this situation was discussed. Dr Clemmensen showed how they handled this complication by deployment of a covered stent on the ostial and proximal RCA. Despite the persistence of an important dissection of the ascending aorta, they decided to wait and watch. The dissection was totally healed at follow-up CT and the RCA was patent.
Finally, Dr R Waksman from Washington, presented a case of severe calcified aortic stenosis in and 81 year old patient, selected for transcatheter aortic valve implantation. An Edwards Sapien valve was implanted, but complicated by severe aortic regurgitation. TEE performed during the procedure confirmed the severe trans-prosthetic regurgitation due to a malfunctioning valve leaflet. Aortic regurgitation was mainly caused by a malfunctioning valve leaflet, which should be treated with a second valve in valve implantation. The implantation of a second valve was complicated by valve migration from the delivery balloon and the valve was retrieved to thoracic aorta and deployed at that level, and finally a third valve was implanted at aortic level with excellent results. The case underlined the importance of TEE during these procedures, which allows us to understand and appropriately treat the mechanism underlying trans-catheter valve failure.

The session was really interesting and showed again how every Interventional Cardiologist one day or another could be confronted with an unexpected procedural complication. Sharing these experiences and discussion is always very useful to enlarge our knowledge on the management of procedural complications, which can often differ from case to case




Complications during percutaneous cardiovascular interventions

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.