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TCTAP C-149 Dangerous Complication: A Stent Lost and Retrieval Case
S272
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. Angioplasty of right coronary artery arising fro left cusp is technically demanding, It requires trial of many guide catheters and support is always an issue in these situations. Doing it in same sitting with LMCA intervention futher increases the procedural risk. This patient had in addition an aorto- osteal dissection which was managed by coronary stent in osteoproximal RCA hanging into aorta. The procedural outcome was satisfactory with patient doing well in long term follow up. TCTAP C-149 Dangerous Complication: A Stent Lost and Retrieval Case Duy Gia Dang1 1 Heart Institute of Ho Chi Minh City, Vietnam [CLINICAL INFORMATION] Patient initials or identifier number. Nguyen N Relevant clinical history and physical exam. The patient is 70 years old, male. He has hypertension for 20 years with the maximum blood pressure is 240/100mmHg. He has hypercholesterol with: Total Cholesterol: 6,24mmol/L LDL-C: 4, 1 mmol/L HDL-L1, 22 mmol/L TG: 4,54 mmol/L He also is a heavy smoker (pack years: 40). Clinical history: -Stable angina CCS-3 Echocardiography: -Echocardiography: normal LV function, EF ¼ 60%. ChestX-ray: -HCR ¼ 0,5 ECG: SR
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S273
Relevant catheterization findings. Femeral acess Sheath 6F Sonde JL,JR 5F Result LM: there was no stenosis LAD: Proximal to mid LAD has 70-80% longsegment lesion LCx: proximal is calcified andtortuosity, has 50-70% stenosis mid LCx has 70-80% stenosis RCA: Stenose 30% at the mid RCA and thedistal RCA
[INTERVENTIONAL MANAGEMENT] Procedural step. Theplan is stenting on both LAD and LCx. Westent on LAD first with a 3.0x45 mm Drug Eluting Stent from the proximal to themid LAD. After that we post dialate with 3.5x 15 mm NC balloon at the proximal ofthe stent with high pressure. The result on LAD was good. We moveto LCx. We try to direct stenting with a 2.75 x15 mm Drug Eluting stent. After several attemps to advance the stent across the lesion, guiding catheter disengaged from LM and pull out the guide wire. Undeployed stent slipped from balloon and remainin proximal LCx. We try to rewirethrough the stent. Two wire and then three wirre twisting tenique was use. Even though small balloon tenique, but the stent still remain in the coronaryartery. Finally we exchange catheter 3F insinde Guiding 6F, using a goosse neck snairto capture the stent and then withdraw all the devices including thedeformed stent through the aorta.
S274
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. -Keep patience. -Few options are available: Wire intertwining, balloon entrapment, snare,stent crush, stent development. -Follow what you are most comfortable. -Beware of lesion characteristics: Tortuosity, Angulation, Calcification, Pass through stent, Kinking of the vessel, Dissections. TCTAP C-150 Left Main Dissection - A Disaster in Cath Lab Jimmy George,1 Rony Mathew2 1 Sri Jayadeva Institute of Cardiovascular Sciences & Research, India; 2 Lisie Hospital, India [CLINICAL INFORMATION] Patient initials or identifier number. A 60 years old male Relevant clinical history and physical exam. A 60 years old male had presented with angina of 1 week, His pulse rate was 76/minute regular with BP of 160/90 mmHg. His ECG was taken and showed Q in V1-4 with deep T inversions suggestive of AWMI. Echocardiography showed wall motion abnormalities in anterior wall with mild LV dysfunction in. Due to ongoing pain he was planned for CAG. Relevant catheterization findings. His CAG was done through right Radial A. It was suggestive of Mid LAD 90% stenosis. [INTERVENTIONAL MANAGEMENT] Procedural step. He was taken up forangioplasty. Right Radial approach was taken 6 Fr sheath an EBU 3.5 guidecatheter passed along and hooked left sinus. A few seconds later there was a BPfall and associated restlessness. A damping was thought and cathetermanipulated a little. There was excruciating angina followed by St elevation, this clicked some bells, the worst night mare was about to come. A shootconfirmed it LMCA dissection. To no wastage of time a 0.014 BMW wire was passedthough it went to LCX, a second 0.014 BMW passed to LAD, a backup of IABR andcardiac surgeons were kept ready. A 3.5 X 48 everolimus stent passed to LMCA-LAD and stented. As angina started settling and ST normalising a breathwas taken and planned for stenting LCX ostium. A 3.0X 30 everolimus stentmountes, a 3.5 X 18 Balloon NC mounted simultaneously to LM-LAD, both weredilated by kissing technique and separately- TAP. Proximal LMCA was postdilated with 4.0X 8 NC at 24 atm. There was good TIMI 3 flow. The angina hadsettled and patient shifted to ICU.
Case Summary. A little caution while hooking was needed, but timely intervention and swift bifurcation stenting prevented major
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. Angioplasty of right coronary artery arising fro left cusp is technically demanding, It requires trial of many guide catheters and support is always an issue in these situations. Doing it in same sitting with LMCA intervention futher increases the procedural risk. This patient had in addition an aorto- osteal dissection which was managed by coronary stent in osteoproximal RCA hanging into aorta. The procedural outcome was satisfactory with patient doing well in long term follow up. TCTAP C-149 Dangerous Complication: A Stent Lost and Retrieval Case Duy Gia Dang1 1 Heart Institute of Ho Chi Minh City, Vietnam [CLINICAL INFORMATION] Patient initials or identifier number. Nguyen N Relevant clinical history and physical exam. The patient is 70 years old, male. He has hypertension for 20 years with the maximum blood pressure is 240/100mmHg. He has hypercholesterol with: Total Cholesterol: 6,24mmol/L LDL-C: 4, 1 mmol/L HDL-L1, 22 mmol/L TG: 4,54 mmol/L He also is a heavy smoker (pack years: 40). Clinical history: -Stable angina CCS-3 Echocardiography: -Echocardiography: normal LV function, EF ¼ 60%. ChestX-ray: -HCR ¼ 0,5 ECG: SR
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S273
Relevant catheterization findings. Femeral acess Sheath 6F Sonde JL,JR 5F Result LM: there was no stenosis LAD: Proximal to mid LAD has 70-80% longsegment lesion LCx: proximal is calcified andtortuosity, has 50-70% stenosis mid LCx has 70-80% stenosis RCA: Stenose 30% at the mid RCA and thedistal RCA
[INTERVENTIONAL MANAGEMENT] Procedural step. Theplan is stenting on both LAD and LCx. Westent on LAD first with a 3.0x45 mm Drug Eluting Stent from the proximal to themid LAD. After that we post dialate with 3.5x 15 mm NC balloon at the proximal ofthe stent with high pressure. The result on LAD was good. We moveto LCx. We try to direct stenting with a 2.75 x15 mm Drug Eluting stent. After several attemps to advance the stent across the lesion, guiding catheter disengaged from LM and pull out the guide wire. Undeployed stent slipped from balloon and remainin proximal LCx. We try to rewirethrough the stent. Two wire and then three wirre twisting tenique was use. Even though small balloon tenique, but the stent still remain in the coronaryartery. Finally we exchange catheter 3F insinde Guiding 6F, using a goosse neck snairto capture the stent and then withdraw all the devices including thedeformed stent through the aorta.
S274
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. -Keep patience. -Few options are available: Wire intertwining, balloon entrapment, snare,stent crush, stent development. -Follow what you are most comfortable. -Beware of lesion characteristics: Tortuosity, Angulation, Calcification, Pass through stent, Kinking of the vessel, Dissections. TCTAP C-150 Left Main Dissection - A Disaster in Cath Lab Jimmy George,1 Rony Mathew2 1 Sri Jayadeva Institute of Cardiovascular Sciences & Research, India; 2 Lisie Hospital, India [CLINICAL INFORMATION] Patient initials or identifier number. A 60 years old male Relevant clinical history and physical exam. A 60 years old male had presented with angina of 1 week, His pulse rate was 76/minute regular with BP of 160/90 mmHg. His ECG was taken and showed Q in V1-4 with deep T inversions suggestive of AWMI. Echocardiography showed wall motion abnormalities in anterior wall with mild LV dysfunction in. Due to ongoing pain he was planned for CAG. Relevant catheterization findings. His CAG was done through right Radial A. It was suggestive of Mid LAD 90% stenosis. [INTERVENTIONAL MANAGEMENT] Procedural step. He was taken up forangioplasty. Right Radial approach was taken 6 Fr sheath an EBU 3.5 guidecatheter passed along and hooked left sinus. A few seconds later there was a BPfall and associated restlessness. A damping was thought and cathetermanipulated a little. There was excruciating angina followed by St elevation, this clicked some bells, the worst night mare was about to come. A shootconfirmed it LMCA dissection. To no wastage of time a 0.014 BMW wire was passedthough it went to LCX, a second 0.014 BMW passed to LAD, a backup of IABR andcardiac surgeons were kept ready. A 3.5 X 48 everolimus stent passed to LMCA-LAD and stented. As angina started settling and ST normalising a breathwas taken and planned for stenting LCX ostium. A 3.0X 30 everolimus stentmountes, a 3.5 X 18 Balloon NC mounted simultaneously to LM-LAD, both weredilated by kissing technique and separately- TAP. Proximal LMCA was postdilated with 4.0X 8 NC at 24 atm. There was good TIMI 3 flow. The angina hadsettled and patient shifted to ICU.
Case Summary. A little caution while hooking was needed, but timely intervention and swift bifurcation stenting prevented major