Clinical expert consensus document on bailout algorithms for complications in percutaneous coronary intervention from the Japanese Association of Cardiovascular Intervention and Therapeutics

Figures

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  Fig. 1. Flowchart for PCI complications. (Green right arrow) Successful (YES). (Red right arrow) Unsuccessful (NO). (Black right arrow) Progress

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  Fig. 2. Flowchart for severe coronary dissection caused by catheter. (Green right arrow) Successful (YES). (Red right arrow) Unsuccessful (NO). (Black right arrow) Progress. (Green circle) Recommended. (Yellow circle) Not recommended, but no other method is available, and successes have been reported. (Red circle) Not recommended. GW, guidewire; PCPS, percutaneous cardiopulmonary support; GC, guiding catheter; IABP, intra-aortic balloon pumping; IVUS, intravascular ultrasound; ADR, antegrade dissection re-entry

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  Fig. 3. Flowchart for coronary perforation. MC, microcatheter

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  Fig. 4. Coil placement techniques using curled coils

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  Fig. 5. IVUS image of high-risk lesions for coronary rupture. IVUS image of a coronary rupture lesion (upper panels, calcified lesions; lower panels, fibrotic lesions). All lesions were highly eccentric and no plaques were observed on the opposite side

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  Fig. 6. IVUS image of extravascular wiring. A IVUS image of extravascular wiring. B The white dotted area on the right is a space created outside the vessel, and the area indicated in red is hypoechoic compared with the healthy perivascular tissue, strongly suggesting an extravascular hematoma. The dotted yellow line indicates the original coronary artery

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  Fig. 7. Flowchart for blowout-type coronary artery rupture

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  Fig. 8. Procedure steps of double GC system/pericardiocentesis trouble

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  Fig. 9. Flowchart for guidewire entrapment or fracture. CTO, chronic total occlusion; GEC, guide-extension catheter

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  Fig. 10. The “Knuckle-twister” technique. This method retrieves a fractured or entrapped guidewire by forming the tip of the polymer-jacketed guidewire into a knuckle of 3–6 cm (A), advancing it slightly distal to the lost wire (B), and pulling it back while continuously drilling until the wire becomes completely entangled with the lost wire (D, E). This figure has been reprinted with permission (Leibundgut et al. [29])

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  Fig. 11. Experimental image of the mechanisms of IVUS entrapment occurrence. Experimental image of IVUS entrapment after stent placement (A). Experimental image during the insertion of a small-diameter balloon or microcatheter (B). The device tip occluded the exit port, leaving no space for entrapment of the stent strut

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  Fig. 12. Flowchart for imaging entrapment