TCTAP C-216 Percutaneous Retrieval of a Migrated Stent in Right Ventricle in Patient with Infective Endocarditis

TCTAP C-216 Percutaneous Retrieval of a Migrated Stent in Right Ventricle in Patient with Infective Endocarditis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017 S303 following angiography showed more than 50% recoil with heavy orga...

1MB Sizes 0 Downloads 23 Views

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017

S303

following angiography showed more than 50% recoil with heavy organized thrombus in Lt iliac artery thus stenting of the Lt iliac artery was done followed by stent optimization by postdilatation balloon, with excellent distal flow angiographically and as shown by post intervention CT angiography.

Case Summary. Conservative management in the form of intense medical therapy may be a good option in patients with extensive thrombosis making immediate intervention risky and non-feasible especially in clinically non critical patient with increased surgical risk. TCTAP C-216 Percutaneous Retrieval of a Migrated Stent in Right Ventricle in Patient with Infective Endocarditis Jaeho Byeon,1 Jang Jaehyuk,1 Ha Wook Park,1 Yoon Seok Koh1 1 The Catholic University of Korea, Seoul St. Mary’s Hospital, Korea (Republic of) [CLINICAL INFORMATION] Patient initials or identifier number. KHS Relevant clinical history and physical exam. An 84-year-old female patient with history of end stage renal disease, diabetes, cerebralinfarction and hypertension presented to emergency department with fever (39.2  C) and dyspnea. Hemodialysis is done three times per week from Oct, 7, 2013.Repeated percutaneous transluminal angioplasty was performed for brachiobasillic fistula stenosis and peripheral stent (Epic, 14 mm x 6 cm) was inserted fifty days ago. Relevant test results prior to catheterization. Laboratory data notable for increased white blood cell count, high sensitivity CRP and ESR. Chest x ray and low dose chest CT revealed about 6 cm sized stent was lodged in right ventricle. Echocardiogram showed the presence of a metallic stent across the tricuspid valve that was causing severe tricuspid regurgitation. Relevant catheterization findings. Percutaneous endovascular retrieval of stent was performed. Under fluoroscopic andechocardiographic guidance, multiple attempts to encircle the stent with a goose-neck snare, intending the lodged stent to buckle, were unsuccessful.After careful attempts of wiring, the migrated stent could be removed with 15 mm multi snare through 16-Fr ultimumum sheath. [INTERVENTIONAL MANAGEMENT] Procedural step. 1) Approach : Rt.femoral and Rt. internal jugular vein approach 2) Sheath : 7Fr sheath è 16Fr ultimatum sheath (Rt. femoral) 3) GW : .035 Terumowire 150 cm (angled), 0.35 Amplatz extra stiff wire 260 cm(cook), Terumo 0.35 x 300 cm Wire 4) Catheter: 6Fr CN catheter, 7Fr JR 4.0 Launcher Guiding Catheter 5) After 6Fr CN catheter was inserted to right atrium, catheter was changed from CN catheter to 7Fr JR guiding catheter. We try to capture previous stent by eV3 Amplatz goose neck snare kit, but it didn’t work.After careful attempts of wiring, the migrated stent could be removed with 15 mm multi snare through 16-Fr ultimatum sheath.

S304

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017

TCTAP C-217 Successful Endovascular Treatment of Bilateral lliofemoral Long CTO Using Retrograde Approach from Deep Femoral Artery Kazuya Shinji1 Synthesis Shinkawabashi Hospital, Japan

1

[CLINICAL INFORMATION] Patient initials or identifier number. S.K. Relevant clinical history and physical exam. A 75 year-old man with a history of hypertension, hyperlipidemia,and tobacco use noted progressive bilateral calf discomfort during activity. Thesesymptoms slowly progressed, and they became so severe that he was unable to exercise.He discussed these symptoms with his primary care physician. His physiciandetected diminished pulses distally. Relevant test results prior to catheterization. His resting ankle brachial index(ABI) was 0.56 on the right and 0.41 on the left. Relevant catheterization findings. An Aortography was performed and it showed chronictotal occlusion (CTO) from right external iliac artery (EIA) to common femoral artery(CFA) and from left external iliac artery (EIA) to superficial femoral artery (SFA).The bilateral deep femoral artery (DFA) was contrasted. [INTERVENTIONAL MANAGEMENT] Procedural step. The 1st EVT for CTO from right EIA to CFA. A 6Fr Sheath less PV was inserted through the right popliteal artery and a 6Fr Sheath less PV was inserted through the left brachial artery, respectively. An antegrade wire was advanced into the distal true lumen. After that we inserted IVUS catheter .The IVUS image showed that wire was in the intra-plaque. Two SMART stents were implanted in the EIA. After that, A long ballooning at the CFA was performed.Final angiography showed the successful recanalization. The 2nd EVT for CTO from left EIA to left SFA. A 6Fr Sheathless PV was inserted through the left popliteal artery and a 6Fr Sheath less PV was inserted through the left brachial artery, respectively. Initially, we inserted two wires into the CTO lesion antegradely and retrogradely. However, both of the wires were into subintimal spaces and we could not track intimal plaque with IVUS guidance.A subintimal angioplasty at CFA poses the risk of occlusion of deep femoral artery(DFA). Therefore, we decided to puncture the DFA. Fortunately a wire was advanced into the proximal true lumen retrogradely through DFA. After that, IVUS catheter was inserted and it showed wire was in the intra plaque at CFA. A hemostasis at DFA puncture site was achieved with ballooning and tronbin. After that we crossed a wire into the SFA antegradely. We implanted SMART stents at EIA and SFA. A long ballooning at the CFA was performed.Final angiography showed the successful re canalization.

Case Summary. Blood culture and retrieved stent culture confirmed methicillin susceptible staphylococcus aureus. After proper antibiotic therapy (nafcillin), clinical symptoms were improved and blood tests were normalized. Follow up culture showed no growth of any bacteria. As endovascular stent placement becomes more frequently utilized by interventional physician.And the incidence of post procedural complications is likely to increase. We successfully treated ineffective endocarditis due to migrated stent by percutaneous retrieval of stent and proper antibiotic therapy.