Bailout technique for the guide extension catheter entrapment by a coronary stent
- PDF / 539,757 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 177 Views
IMAGES IN CARDIOVASCULAR INTERVENTION
Bailout technique for the guide extension catheter entrapment by a coronary stent Masaomi Gohbara1 · Teruyasu Sugano1 · Masatoshi Narikawa1 · Toshiyuki Ishikawa1 · Kouichi Tamura1 · Kazuo Kimura1,2 Received: 12 September 2020 / Accepted: 29 October 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Case An 83-year-old women underwent percutaneous coronary intervention to right coronary artery (RCA). After coronary orbital atherectomy and balloon dilatation, a stent (XienceSierra 3.5/23 mm) was implanted into the RCA mid lesion using a guide extension catheter (EC) (GUIDEPLUSIIST, 5.3Fr). During a stent (XienceSierra 3.5/15 mm) was adjusted to cover the ostial lesion, the EC was unintentionally advanced to the RCA. Since the tip of it was less visible, we could not find the tip’s position. As a result, the stent was inflated distally 5 mm in the RCA and proximally 10 mm into the EC (Fig. 1). First, we tried to retrieve the EC leaving deflated stent balloon (SB) at the initial position. However, it was difficult. Eventually, the proximal shaft of the EC was detached at the connection from the distal tube (cylindrical tube, 25 cm) by pulling. Next, we pulled the SB to the proximal then trapped the EC by inflating the SB (16 atm). After swaging the stent by intentional advancing the guiding catheter (GC) (6Fr-SAL1.0, Hyperion) with pulling the shaft of the SB which trapped the detached distal tube of the EC
anchoring at the position of entrapment by the stent (Fig. 1, Video), the stent was retrieved together with them and a new same stent was implanted. GUIDEPLUS has a good trackability, whereas the tip is less visible. Although Higuchi et al. reported retrieving the SB was effective for GUIDEPLUS entrapment, [1] their method might be difficult in cases with severe entrapment. In addition, only advancing GC into the coronary artery (CA) was secure method for removal of the stent. Anchoring at the distal to the lesion is another method; however, there is a risk of irretrievable SB. On the other hand, if this EC entrapment occurs in the distal of the CA, our method may be difficult and we need double GC. If 2nd guidewire from 2nd GC can cross outside of the stent, stent crushing by ballooning enables to bail out. If 2nd guidewire can cross not outside of the stent but only the stent strut, ballooning at the tip of the EC may enable to release EC entrapment leaving the stent in the CA. After that, the stent can be fixed if the 1st guidewire remains, or retrieved using a snare. Our bailout method is good option for EC entrapment at the proximal of the CA even in cases with severe entrapment.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12928-020-00730-x) contains supplementary material, which is available to authorized users. * Masaomi Gohbara [email protected] 1
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3‑9 Fukuura, Kanazaw
Data Loading...
