Figure 1- angiogram showing critical stenosis of proximal/medium RCA and
a critical lesion at bifurcation between distal RCA and PLA (left
profile projection).
Operator called an Heart Team discussion to decide the better strategy
to patient, either conservative or cardiothoracic surgery in order to
remove intracoronary guidewire. Considering anatomical and technical
issues that made unlikely the success of the surgical approach and after
risk-to-benefit considerations, experts decided to choose the
conservative approach. On the other hand, It was decided to implant a
coronary stent in PLA and were implanted two other coronary stents: at
the proximal extremity of the first stented lesion to correct a proximal
dissection (ONYX 3,5x34m) and at proximal RCA
(ONYX 4,0x34 mm) overinflated with high-pressure NC balloon (4x8mm).
(figure 2). This strategy sought stabilization of total guidewire
alongside RCA to promote endothelialization of the tip of trapped
guidewire in coronary vessel wall reducing the risk of in situ
thrombosis.