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TCTAP C-136 Successful Retrieval of Fractured Fragment of Entrapped Stent at Ostium of Right Coronary Artery
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S257
Relevant catheterization findings. CAG was performed again. In LAD and proximal RCA, restenosis was not detected. But moderate lesion in middle RCA was progressed. So, PCI was performed.
Case Summary. Coronaryartery perforation is arare, but particularly feared and sometimes life-threatening, complication ofpercutaneous coronary interventions. The incidence of coronary perforation hasincreased with more invasive interventional devices as the rotablation. Weexperienced a case of Ellis grade2 perforation following a balloon dilatationand stent implantation performed in severe calcification lesion. TCTAP C-136 Successful Retrieval of Fractured Fragment of Entrapped Stent at Ostium of Right Coronary Artery Jun Yamashita,1 Nobuhiro Tanaka,2 Kunihiro Sakoda,1 Kou Hoshino,1 Naotaka Murata3 1 Tokyo Medical University, Japan; 2Tokyo Medical University Hachioji Medical Center, Japan; 3Tokyo Medical University Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. S.N Relevant clinical history and physical exam. The patient was 60’s male and was suffering from hypertension, dyslipidemia and diabetes mellitus. He received PCIs for proximal and middle LAD and proximal RCA 9 months ago as treatments of unstable angina pectoris. Relevant test results prior to catheterization. Moderate residual stenoses had been recognized in middle and distal RCA when the PCI for RCA had been performed, therefore exercise electrocardiography was done in outpatient clinic and ST depression was detected.
S258
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. Procedure Initial Approach: Rt. Radial artery Guiding Catheter 6Fr IL3.5 (Terumo) Guide wire: Runthrough Extra Floppy (Terumo) After Complication (System was changed) Approach: Rt. Femoral artery Guiding Catheter 7Fr SAL1.0 (Asahi) Guide wire: Sion (Asahi) Wire crossing was easy and pre dilatation for target lesion was done. After pre dilatation, we tried to deliver DES (3x33mm) for the target lesion, but this stent was entrapped at proximal portion of RCA, where previous stent had been deployed. Stent was fallen out from delivery balloon easily. For retrieval of entrapped stent, we advanced Goose Neck Snare (4mm) along guide wire, caught the proximal site of stent, and pulled back it. But, entrapped stent elongated, fractured and one third fragment of stent remained in RCA. Proximal end of remained fragment was recognized at outside of RCA ostium. Approach site was changed from radial artery to femoral artery and guiding catheter was changed from IL3.5 (6Fr) to SAL1 (7Fr). Guide wire was advanced to distal RCA again. We advanced Ensnare (8mm) along guide wire and caught the proximal end of remained fragment and could remove the fractured fragment of stent. After that, two DESs were deployed at initial target lesion and proximal RCA.
Case Summary. Using two different snares, we could remove entrapped stent at proximal portion of RCA. Recent year, entrapping and dislodging of stent have been rare complications, but we have to master the bailout of these complications. TCTAP C-137 Two Years Follow-up of a Case with Peri-stent Contrast Staining After Implanting 2 Types of Second-generation Drug-eluting Stents, Resulted in Coronary Thrombosis During Intravascular Ultrasound Procedure Tetsuro Kataoka,1 Kazuhiro Anzaki1 1 National Hospital Organization Kagoshima Medical Center, Japan [CLINICAL INFORMATION] Patient initials or identifier number. K.K Relevant clinical history and physical exam. A 69 years old female patient underwent coronary angiogram for preoperative examination of abdominal aortic aneurysm in June, 2012. She had coronary risk factors such as hypertension, dyslipidemia, and current smoking.
S257
Relevant catheterization findings. CAG was performed again. In LAD and proximal RCA, restenosis was not detected. But moderate lesion in middle RCA was progressed. So, PCI was performed.
Case Summary. Coronaryartery perforation is arare, but particularly feared and sometimes life-threatening, complication ofpercutaneous coronary interventions. The incidence of coronary perforation hasincreased with more invasive interventional devices as the rotablation. Weexperienced a case of Ellis grade2 perforation following a balloon dilatationand stent implantation performed in severe calcification lesion. TCTAP C-136 Successful Retrieval of Fractured Fragment of Entrapped Stent at Ostium of Right Coronary Artery Jun Yamashita,1 Nobuhiro Tanaka,2 Kunihiro Sakoda,1 Kou Hoshino,1 Naotaka Murata3 1 Tokyo Medical University, Japan; 2Tokyo Medical University Hachioji Medical Center, Japan; 3Tokyo Medical University Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. S.N Relevant clinical history and physical exam. The patient was 60’s male and was suffering from hypertension, dyslipidemia and diabetes mellitus. He received PCIs for proximal and middle LAD and proximal RCA 9 months ago as treatments of unstable angina pectoris. Relevant test results prior to catheterization. Moderate residual stenoses had been recognized in middle and distal RCA when the PCI for RCA had been performed, therefore exercise electrocardiography was done in outpatient clinic and ST depression was detected.
S258
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. Procedure Initial Approach: Rt. Radial artery Guiding Catheter 6Fr IL3.5 (Terumo) Guide wire: Runthrough Extra Floppy (Terumo) After Complication (System was changed) Approach: Rt. Femoral artery Guiding Catheter 7Fr SAL1.0 (Asahi) Guide wire: Sion (Asahi) Wire crossing was easy and pre dilatation for target lesion was done. After pre dilatation, we tried to deliver DES (3x33mm) for the target lesion, but this stent was entrapped at proximal portion of RCA, where previous stent had been deployed. Stent was fallen out from delivery balloon easily. For retrieval of entrapped stent, we advanced Goose Neck Snare (4mm) along guide wire, caught the proximal site of stent, and pulled back it. But, entrapped stent elongated, fractured and one third fragment of stent remained in RCA. Proximal end of remained fragment was recognized at outside of RCA ostium. Approach site was changed from radial artery to femoral artery and guiding catheter was changed from IL3.5 (6Fr) to SAL1 (7Fr). Guide wire was advanced to distal RCA again. We advanced Ensnare (8mm) along guide wire and caught the proximal end of remained fragment and could remove the fractured fragment of stent. After that, two DESs were deployed at initial target lesion and proximal RCA.
Case Summary. Using two different snares, we could remove entrapped stent at proximal portion of RCA. Recent year, entrapping and dislodging of stent have been rare complications, but we have to master the bailout of these complications. TCTAP C-137 Two Years Follow-up of a Case with Peri-stent Contrast Staining After Implanting 2 Types of Second-generation Drug-eluting Stents, Resulted in Coronary Thrombosis During Intravascular Ultrasound Procedure Tetsuro Kataoka,1 Kazuhiro Anzaki1 1 National Hospital Organization Kagoshima Medical Center, Japan [CLINICAL INFORMATION] Patient initials or identifier number. K.K Relevant clinical history and physical exam. A 69 years old female patient underwent coronary angiogram for preoperative examination of abdominal aortic aneurysm in June, 2012. She had coronary risk factors such as hypertension, dyslipidemia, and current smoking.