case_images: PMC10482517_01
case_images: RCA perforation. Fluoroscopy of the RCA showing. (a) Wire outside the vessel architecture (arrow). (b) Contrast extravasation (circle). (c) Illustration of RCA perforation (arrow).
case_images: CRIC2023-6640439.001.jpg
case_images: PMC10482517_01_CRIC2023-6640439.001.jpg
case_images: fig1
case_images: During the procedure, the distal part of the wire was observed outside the RCA architecture, and contrast extravasation occurred, leading to the suspension of the procedure (Figure 1).
case_images: Wire entering extraplaque space, subintimal transcatheter withdrawal technique, and reentry to the posterolateral artery true lumen. (a) False lumen hematoma before subintimal transcatheter withdrawal technique. (b) Subintimal transcatheter withdrawal technique. Aspiration is performed by decompressing the hematoma through the STINGRAY  and allowing re-expansion of the distal true lumen. (c) Reentry to the posterolateral artery true lumen using the stick and swap. (d) Distal position of the wire in the posterolateral artery (PLA) lumen.
case_images: CRIC2023-6640439.002.jpg
case_images: PMC10482517_01_CRIC2023-6640439.002.jpg
case_images: fig2
case_images: Scientific Corporation, Marlborough, MA, USA), and the CTO body traversed with a FIGHTER  wire (Boston Scientific Corporation) over a MAMBA  Flex microcatheter wire (Boston Scientific Corporation), but the distal true lumen was not reached. FIGHTER  wire was advanced to the proximal posterolateral artery (PLA), entering the false lumen, and then a STINGRAY  system (Boston Scientific Corporation) was delivered to drain 5 cc from the subintimal hematoma with the STRAW (subintimal transcatheter withdrawal) technique. Subsequently, a reentry to the PLA true lumen was achieved using the stick and swap technique (Figure 2).
case_images: Pre-stent implantation arteriography illustration and final angiographic result. (a) Lesion in the middle segment of the RCA, with signs of dissection and a microchannel filling the distal segment of the artery. Blue arrow: Cross-section showing true lumen (A) and false lumen (B). Intravascular ultrasound demarcated false lumen (FL) true lumen (TL) and wire (arrow). (b) Purple arrow: proximal segment of the stent in the true lumen (A). Blue arrow: distal segment of the stent in the false lumen (B). (c) Final angiographic result (A) and illustration (B), following successful angioplasty with stent implantation.
case_images: CRIC2023-6640439.003.jpg
case_images: PMC10482517_01_CRIC2023-6640439.003.jpg
case_images: fig3
case_images: Control angiography demonstrated a satisfactory result (Figure 3).