Webinar 3 | Step-by-Step Approach to Treating Complications-Step-by-Step Approach to Treating Complications

Video Transcription

Video Summary

The webinar, moderated by Dawn Abbott for the SC&I Bifurcation Club, focused on a step-by-step approach to managing bifurcation PCI complications. Dr. Kevin Cross discussed jailed wires, emphasizing prevention: keep jailed segments short, avoid high-pressure ballooning before removing the wire, and use local traction with balloons or microcatheters close to the trap. He reviewed cases where trapped wires were retrieved with guide extenders and microcatheters, and when fracture techniques such as rota-assisted wire fracture may be needed. Panelists discussed whether knuckled or jacketed wires are safer; the group generally preferred non-jacketed wires and cautioned against trapping pressure wires.<br /><br />Dr. Jason Wohlmuth reviewed perforation management, especially when a bifurcation side branch is involved. He highlighted the added danger of hemodynamic compromise and ischemia, then walked through strategies including covered stents, jailed-balloon techniques, and, importantly, puncturing back through a covered stent into a side branch using penetrating wires and microcatheters. He presented a complex rescue case using dual covered stents, side-branch stenting as a target, and kissing balloon inflation to restore flow while sealing the perforation.<br /><br />Dr. Manos Berlakis covered how to manage inability to cross or recross bifurcations. He stressed using alternate wires, dual-lumen or angulated microcatheters, vessel preparation, and guide-extension or anchor techniques to improve deliverability. When balloons or stents could not cross, he recommended escalating support and using imaging to clarify whether calcium or dissection was limiting progress.<br /><br />Across all talks, the key themes were prevention, recognizing the mechanism of failure, using specialized tools thoughtfully, and treating the patient rather than the fluoroscopy.

Asset Subtitle

J. Dawn Abbott, MD, MSCAI; Emmanouil S. Brilakis, MD, PhD, FSCAI; Kevin J. Croce, MD, PhD, FSCAI; Bryan Kindya, MD; Jason R. Wollmuth, MD, FSCAI

Asset Caption

closed captions are computer-generated

Keywords

bifurcation PCI

jailed wire

wire entrapment

perforation management

covered stent

side-branch recrossing

microcatheter

guide extender

rotablation

intravascular lithotripsy

coronary perforation

side branch salvage

atherectomy

calcium

laser

orbital

plaque

kissing balloon inflation

jailed wires

covered stents

microcatheters

guide extenders

wire fracture

side branch stenting

bifurcation complications