RCA functional CTO. All good till we pulled out the wire, Then it was obvious. What to do next.

What we did. Balloon fragment embolization. 2.0x15mm Balloon cut into two parts. Both parts were loaded over the wire and embolized the distal free segment into the small side branch with effective sealing. Retrograde check no leak from collaterals.

Doesnt seem to be bleeding into pericardial space. Inflate 1:1 sized in PL for few minutes. Get echo to rule out effusion. Most likely balloon tamponade will take care of it. If not, fat/coil embolization.

Yes, great thought. Universal algorithm. Have you ever tried anything else, Other than fat, coil, foam etc.

Recently we used catgut suture cut in to small pieces and delivered it through microcatheter It got sealed off

I have experience with vicryl suture embolization through MC for same reason.

It’s staining there not pouring… It will be contained. Nothing to do if no worsening efffusion

No special leak. U can just leave it without searching for more trouble.

What wire was it?

Pilot 50

Easy cheaper way is to leave cut balloon

That's what we did.