Pressure-controlled intermittent coronary sinus occlusion (PICSO) improves microvascular perfusion in ischaemic areas of the myocardium by intermittently increasing wedge pressure, using a balloon-tipped catheter introduced into the coronary sinus (CS). No experience exists using PICSO to relieve myocardial ischaemia during PCI.
A 75-year-old man with severe left ventricular dysfunction (ejection fraction 25%) and prior mechanical aortic valve replacement presented with heart failure. Critical calcified distal left main (LM) stenosis (Medina 1,1,1) (Panel A) was diagnosed. As coronary bypass surgery was deemed too risky (EuroSCORE 32%), LM PCI under mechanical support was chosen. Severe peripheral vascular disease and mechanical aortic valve ...
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