2016TCTAP case presentation-Inadvertent Extraction of a Drug Eluting Stent with an Aspiration Catheter During Primary Percutaneous Coronary Intervention
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Inadvertent Extraction of a Drug Eluting Stent with an Aspiration Catheter During Primary Percutaneous Coronary Intervention
[CLINICAL INFORMATION]
Patient initials or identifier number.
CWY
Relevant clinical history and physical exam.
A 45-year-old male smoker with type 2 diabetes and hyperlipidemia presented to our hospital with sudden onset of chest pain for 4 hours, bradycardia(HR 53/min) and low blood pressure (BP 76/56 mmHg).
Risk Factors: type 2 diabetes mellitus, hyperlipidemia, and smoking.
Relevant test results prior to catheterization.
ECG: Sinus rhythm; 60/min;
ST elevation at II, III & aVF; ST depression at I, aVL and V4-V6
UCG: LV asynergy: severe hypokinesis of the mid-basal inferior wall of LV, normal valve function, Global EF: 40%.
cTn-I: Elevated
Relevant catheterization findings.
Thrombotic total occlusion in the middle right coronary artery.
[INTERVENTIONAL MANAGEMENT]
Procedural step.
1. Perform LCA angiography;
2. Perform RCA angiography;
3. Perform RCA-PCI with Guiding (6Fr JR 3.5) and Guide wire (SION).
4. Implant Stent (BioMatrix 3.5*18mm and then Orsiro 3.5*40mm)
5. Aspiration thrombectomy device: Thrombuster II aspiration catheter (6Fr)
An angiography revealed that his middle RCA was totally occluded.
Subsequently, a 6-Fr JR 3.5 guiding catheter was inserted through the right femoral artery, and A 0.014-inch SION guidewire with a 45+ tip was then advanced to the distal end of RCA. Thrombectomy was performed gently using a 6Fr Thrombuster II aspiration catheter, and stenting was performed with a 3.5/18 mm BioMatrix stent at 14 atmospheres after balloon predilatation. However, repeat angiography revealed TIMI grade 2 flow and thrombus formation at distal RCA was
highly suspected. Rewiring to distal RCA by Extra-Support wire was performed due to unintentionally withdraw wires after stenting. Thromboaspiration with Thrombuster II aspiration catheter was performed again with difficulty of passing the device through the proximal and middle portion of deployed right coronary stent.
During its removal, the thrombectomy catheter was hooked with the right coronary
stent, inadvertently dislodging and extracting it entirely. A large spiral coronary dissection was confirmed by angiography. Another drug-eluting stent (Orsiro 3.5/40mm) was implanted in the
RCA covering the dissected endothelium, achieving excellent immediate results.
Case Summary.
The current case suggests that there is a potential risk associated with retrieving the aspiration thrombectomy device. To achieve correct wiring through the previously stented segment or
bifurcation, creating a loop in the tip of the guidewire as it passes through the stent, and then straightening it to advance to the distal vessel, decreases the possibility that the wire has passed through a cell of a stent and went into the abluminal space between the vessel wall and stent.
Inadvertent Extraction of a Drug Eluting Stent with an Aspiration Catheter During Primary Percutaneous Coronary Intervention
Guo-Shiang Tseng1, Jun-Ting Liou2
Taoyuan Armed Forces General Hospital, Taiwan1, Tri-Service General Hospital, National Defense Medical Center, Taiwan2
[CLINICAL INFORMATION]
Patient initials or identifier number.
CWY
Relevant clinical history and physical exam.
A 45-year-old male smoker with type 2 diabetes and hyperlipidemia presented to our hospital with sudden onset of chest pain for 4 hours, bradycardia(HR 53/min) and low blood pressure (BP 76/56 mmHg).
Risk Factors: type 2 diabetes mellitus, hyperlipidemia, and smoking.
Relevant test results prior to catheterization.
ECG: Sinus rhythm; 60/min;
ST elevation at II, III & aVF; ST depression at I, aVL and V4-V6
UCG: LV asynergy: severe hypokinesis of the mid-basal inferior wall of LV, normal valve function, Global EF: 40%.
cTn-I: Elevated
Relevant catheterization findings.
Thrombotic total occlusion in the middle right coronary artery.
[INTERVENTIONAL MANAGEMENT]
Procedural step.
1. Perform LCA angiography;
2. Perform RCA angiography;
3. Perform RCA-PCI with Guiding (6Fr JR 3.5) and Guide wire (SION).
4. Implant Stent (BioMatrix 3.5*18mm and then Orsiro 3.5*40mm)
5. Aspiration thrombectomy device: Thrombuster II aspiration catheter (6Fr)
An angiography revealed that his middle RCA was totally occluded.
Subsequently, a 6-Fr JR 3.5 guiding catheter was inserted through the right femoral artery, and A 0.014-inch SION guidewire with a 45+ tip was then advanced to the distal end of RCA. Thrombectomy was performed gently using a 6Fr Thrombuster II aspiration catheter, and stenting was performed with a 3.5/18 mm BioMatrix stent at 14 atmospheres after balloon predilatation. However, repeat angiography revealed TIMI grade 2 flow and thrombus formation at distal RCA was
highly suspected. Rewiring to distal RCA by Extra-Support wire was performed due to unintentionally withdraw wires after stenting. Thromboaspiration with Thrombuster II aspiration catheter was performed again with difficulty of passing the device through the proximal and middle portion of deployed right coronary stent.
During its removal, the thrombectomy catheter was hooked with the right coronary
stent, inadvertently dislodging and extracting it entirely. A large spiral coronary dissection was confirmed by angiography. Another drug-eluting stent (Orsiro 3.5/40mm) was implanted in the
RCA covering the dissected endothelium, achieving excellent immediate results.
Case Summary.
The current case suggests that there is a potential risk associated with retrieving the aspiration thrombectomy device. To achieve correct wiring through the previously stented segment or
bifurcation, creating a loop in the tip of the guidewire as it passes through the stent, and then straightening it to advance to the distal vessel, decreases the possibility that the wire has passed through a cell of a stent and went into the abluminal space between the vessel wall and stent.
