Trapped Guide Extension Catheter Technique for Management of Coronary Artery Perforation in a Balloon Uncrossable Lesion.

OBJECTIVE

The purpose of this report is to describe the use of a trapped guide extension catheter technique in the treatment of coronary artery perforations in heavily calcified and uncrossable segments.

KEY STEPS

Following a coronary artery perforation, stabilize the patient and maintain hemostasis with a tamponading balloon from the first guide catheter (GC). Obtain separate arterial access and introduce a second GC. Disengage the first GC and engage with the second GC. Rewire from the second GC with brief deflations of the tamponading balloon. This can be facilitated by trapping a microcatheter between the tamponading balloon to allow time to wire while maintaining hemostasis. Introduce a guide extension catheter via the second GC into the coronary artery, align the tamponading ballon from the first GC, and inflate at low pressures to the trap the guide extension catheter. Proceed with deployment of covered stent/percutaneous coronary intervention making use of this strong support.

POTENTIAL PITFALLS

The potential pitfalls include the following: 1) prolonged inflation of trapping balloon may cause ischemia and hypotension, and 2) caution when used in proximal vessels that subtend a large area of the myocardium. Excessively high-pressure inflation of the trapping balloon may damage the coronary artery.