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Explore Case 132: Manual of PCI - PCI through 2 TAVRs with 3,347 views, 65 likes, and 9 comments. Experience the impact of this video content that has captured audience attention.

A patient with two prior TAVR procedures (31 mm CoreValve implanted 6 years prior and 29 mm Sapien 3 implanted 2 years prior) presented with chest pain and inferior ischemia. Coronary angiography was challenging: a JR4 diagnostic catheter failed to engage but engagement was achieved with a 6 French multipurpose diagnostic catheter. The culprit lesion was a 90% mid RCA lesion. Engagement with a JR4 and a multipurpose guide catheter failed. We engaged the right coronary artery with a multipurpose diagnostic catheter and inserted a workhorse wire and a 300 cm long Grand Slam guidewire. We removed the diagnostic catheter leaving the Grand Slam guidewire in place and inserted a JR4 guide catheter over the Grand Slam wire. We then inserted a 6 French guide catheter extension that improved engagement of the right coronary artery. OCT suggested that the lesion was a calcified nodule. We performed several runs of orbital atherectomy followed by successful balloon expansion and DES implantation.

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