# When 3 Fundamentals of Disaster Meet During Elective PCI

## TL;DR

A patient undergoing elective heart procedure faced multiple complications, leading to fatal outcomes despite advanced interventions.

## Contribution

Demonstrates a rare convergence of multiple PCI-related hazards and their management in a vulnerable patient.

## Key findings

- Five PCI-related hazards occurred in a single patient during elective procedure.
- Interventions included balloon occlusion, coiling, and stent recovery techniques.
- Patient succumbed to cardiogenic shock despite extensive resuscitation efforts.

## Abstract

The disaster risk is probabilistically defined as a function of hazard, vulnerability, and capacity. Here, we report a case of a vulnerable patient who underwent elective percutaneous coronary intervention for symptomatic ischemic heart disease in whom a series of 5 percutaneous coronary intervention–related hazards occurred: distal coronary perforation; ischemia-driven electrical storm; no reflow; coronary vessel rupture; and stent dislodgement. These complications were managed using several interventional techniques including immediate balloon occlusion, distal vessel coiling, drug-eluting stent implantation, recovery of a dislodged drug-eluting stent on the fractured wire using a self-made snare and finally crushing of a stent graft against the vessel wall. Despite these efforts, prolonged resuscitation and limited patient-related capacities were unfavorable and the patient died due to cardiogenic shock.