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

Slow/No Reflow u % u Long lesions u Heavy calcification u Small vessels u Long rotablation time u Intra luminal filling defects

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

Coronary Dissection u 12.8% u Burr size & adjuvant PTCA u Angiography u IVUS u Angioscopy u Post mortem

Coronary Dissection u Proper Burr size u Control RPM u Prolonged balloon inflation u Atherectomy u Stenting u CABG

Coronary Perforation u % u >RCA & Cx X LAD u Eccentricity u Tortuosity u Lesion > 10mm u Guide wire Bias u Total occlusion

Coronary Perforation u Guiding catheter alignment u Conservative u Prolonged balloon inflation u ? Stenting u Graft stent u CABG

Jostent Coronary Stent Graft

NACI Registry u 525 patients, 670 lesions u Death 0.5% % u Emergency CABG 0.4% % u MI 6% (Non-Q 5%) % u Dissection 12-15% u Side branch occlusion 3% % u Distal embolization 3%