Successful transdradial removal of a dislodged coronary stent

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Presentation transcript:

Successful transdradial removal of a dislodged coronary stent Italo Porto Interventional Cardiology Unit Università Cattolica del Sacro Cuore Rome, Italy Fondi, 28 Giugno 2008

Italo Porto, MD, PhD DISCLOSURES I have no real or apparent conflicts of interest to report.

Case Male, 66 years High blood pressure, hypercholesterolemia, family history of cardiovascular disease History of coronary artery disease from 2007 with previous PCI on RCA (BMS) and LAD (DES) Relapse of angina in August 2008 with positive exercise stress test Fondi, 28 Giugno 2008 3

Coronary angiography Fondi, 28 Giugno 2008 RCA: ostial 85% lesion proximally to previously implanted stent Fondi, 28 Giugno 2008 4

Coronary angiography Fondi, 28 Giugno 2008 LAD: mid-distal 55% lesion no instent restenosis; LCX: distal collateralized occlusion Fondi, 28 Giugno 2008 5

Revascularization strategy Percutaneous coronary intervention to proximal right coronary artery Drug pre-treatment: ASA 100 mg daily, clopidogrel loading dose 300 mg Anticoagulation: heparin 100 UI/kg  ACT >250 sec Vascular Access: Right radial artery Guiding catheter: Judkins Right 4 6F Fondi, 28 Giugno 2008 6

Wires in Guide Wire: 2xBalance Middleweight Universal 0.014” Fondi, 28 Giugno 2008 7

Stent: Chrono Carbostent 3.5 x 16 mm Direct stenting Stent: Chrono Carbostent 3.5 x 16 mm Fondi, 28 Giugno 2008 8

Incomplete ostial coverage Fondi, 28 Giugno 2008 9

Stent: Chrono Carbostent 3.5 x 8 mm Overlap stenting Stent: Chrono Carbostent 3.5 x 8 mm Fondi, 28 Giugno 2008 10

Ooopss…..

A simple solution to a complex problem ? Wrong!!!

Capture of dislodged stent Fondi, 28 Giugno 2008 13

Stent withdrawal Fondi, 28 Giugno 2008 14

Stent withdrawal Fondi, 28 Giugno 2008 15

What next? A 3.5 mm deployed stent is engaging the right radial artery The 6 French radial sheath is exchanged for a 7 French one over the two wires An Amplatz GOOSE NECK Microsnare 4 system is implemented to achieve stent removal Size Matters Fondi, 28 Giugno 2008 16

Korean group, CCI 2001

Stent snaring Fondi, 28 Giugno 2008 18

Stent snaring Fondi, 28 Giugno 2008 19

Stent removal Fondi, 28 Giugno 2008 20

Stent: Chrono Carbostent 4.0 x 12 mm Ostium stenting Stent: Chrono Carbostent 4.0 x 12 mm Fondi, 28 Giugno 2008 23

Final result Fondi, 28 Giugno 2008 24

Final radial artery angiography Fondi, 28 Giugno 2008 25

Discussion Stent dislodgement is an uncommon PCI complication which can be secondary to severe coronary angulation, coronary calcification, and direct stenting Two previous report described transradial stent retrieval using small-balloon technique and forceps We describe a safe and successful retrieve of a coronary stent dislodged in ascending aorta using a Microsnare system Fondi, 28 Giugno 2008 26

Thank You!!!