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Complications of HSRA

Complications of HSRA. Layth A. Mimish Consultant Cardiologist Cardiovascular Consultants Group Jeddah , Saudi Arabia. Slow/No Reflow. 1.8-17 % Long lesions Heavy calcification Small vessels Long rotablation time Intra luminal filling defects. Slow/No Reflow.

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Complications of HSRA

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  1. Complications of HSRA Layth A. Mimish Consultant Cardiologist Cardiovascular Consultants Group Jeddah , Saudi Arabia

  2. Slow/No Reflow • 1.8-17 % • Long lesions • Heavy calcification • Small vessels • Long rotablation time • Intra luminal filling defects

  3. Slow/No Reflow • Pre-treatment, peri-procedural • Frequent flushing • Short Burr time • Flush solution • Maintain coronary perfusion pressure, Inotropes /IABP

  4. Coronary Dissection • 12.8% • Burr size & adjuvant PTCA • Angiography • IVUS • Angioscopy • Post mortem

  5. Coronary Dissection • Proper Burr size • Control RPM • Prolonged balloon inflation • Atherectomy • Stenting • CABG

  6. Coronary Perforation • 0.6-0.7 % • >RCA & Cx X LAD • Eccentricity • Tortuosity • Lesion > 10mm • Guide wire Bias • Total occlusion

  7. Coronary Perforation • Guiding catheter alignment • Conservative • Prolonged balloon inflation • ? Stenting • Graft stent • CABG

  8. Jostent Coronary Stent Graft

  9. NACI Registry • 525 patients, 670 lesions • Death 0.5% ---------- 1% • Emergency CABG 0.4% -------1.4% • MI 6% (Non-Q 5%) ---------3.4% • Dissection 12-15% • Side branch occlusion 3% ------7.5% • Distal embolization 3%

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