Navigating Unanticipated Complications in Percutaneous Coronary Intervention: A Case Report of Elective PCI Turning into Primary PCI for RCA Stenosis

Abstract

Background: Percutaneous coronary intervention (PCI) is a cornerstone in the management of coronary artery disease, offering a minimally invasive approach to restore blood flow in obstructed coronary arteries. However, unexpected complications can arise during these procedures, necessitating rapid adaptation and intervention to ensure optimal patient outcomes.

Case Presentation: We present the case of a 73-year-old male with effort angina and multiple comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. Scheduled for elective PCI due to a moderate-tight lesion in the proximal right coronary artery (RCA), the procedure swiftly transitioned into a primary PCI scenario following abrupt vessel closure and ST-segment elevation. Diagnostic assessment revealed the need for immediate intervention to address potential causes such as thrombus, dissection, or air embolism.

Management & Results: A multidisciplinary team employed a systematic approach, utilizing aspiration thrombectomy, stent placement, balloon dilatation, and intracoronary medications to restore coronary flow and manage complications. Despite challenges including hypotension and bradycardia, sequential interventions successfully addressed thrombus burden and ostioproximal dissection. Pharmacological agents were administered to optimize coronary perfusion, leading to improved antegrade flow with residual haziness in distal vessels.

Conclusion: This case underscores the complexity of managing unanticipated complications during PCI, emphasizing the importance of rapid recognition, multidisciplinary teamwork, and advanced interventional techniques. Through meticulous assessment and targeted interventions, optimal outcomes can be achieved, highlighting the critical role of preparedness and adaptability in navigating PCI procedures.