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

2. Slow/No Reflow u 1.8-17 % u Long lesions u Heavy calcification u Small vessels u Long rotablation time u Intra luminal filling defects

3. 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

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

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

6. Coronary Perforation u 0.6-0.7 % u >RCA & Cx X LAD u Eccentricity u Tortuosity u Lesion > 10mm u Guide wire Bias u Total occlusion

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

8. Jostent Coronary Stent Graft

9. NACI Registry u 525 patients, 670 lesions u Death 0.5% ---------- 1% u Emergency CABG 0.4% -------1.4% u MI 6% (Non-Q 5%) ---------3.4% u Dissection 12-15% u Side branch occlusion 3% ------7.5% u Distal embolization 3%