- Email: [email protected]
TCTAP C-222 Incidence of Floating Stent Fracture 141 Months After Luminexx Nitinol Stent Implantation in the Superficial Femoral Artery
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S371
After continuous CDT for 9 days, venography showed restoration of blood flow, which was not sufficient. IVUS revealed massive residual thrombus. We decided to add surgicalthrombectomy. The Cardiovascular surgeons removed as much thrombus as possible by 4Fr Fogarty catheter. After removal of thrombus, we noticed the sufficient blood back flow. A 4Fr catheter was inserted into the AVF at the skin incision site and a 0.014 wire was passed to the SCV. IVUS revealed significant narrowing in the SCV through the proximal cephalic vein due to intimal hyperplasia with residual thrombus. Because of clinical history of frequent recurrence, we put a Smart stent 8 / 80 mm (Cordis, CA, the US) to cover the SCV to the proximal cephalic vein, followed by 5 mm balloon dilatation. Final angiogram revealed excellent antegrade blood flow with minimal residual stenosis. Her AVF remained open under oral anticoagulation.
Case Summary. We reported the case with successful restoration of blood flow in the AVF using combination with CDT, surgical thrombectomy and stent implantation in the central vein after 3 weeks of total thrombotic occlusion. In general, once AVF became obstructed with massive thrombus, we give up restoring the blood flow. We could say that CDT might be worth trying for relatively aged thrombus. For young HD patient, durability of AVF is a crucial issue. Therefore, we expect stent implantation may help prolong the life of AVF, though we need to carefully access the patency of stent in this portion. We concluded that hybrid therapy should be considered when we treat this kind of complicated case. TCTAP C-222 Incidence of Floating Stent Fracture 141 Months After Luminexx Nitinol Stent Implantation in the Superficial Femoral Artery Takuya Tsujimura,1 Osamu Iida,1 Shin Okamoto,1 Takayuki Ishihara,1 Kiyonori Nanto,1 Tatsuya Shiraki,1 Shota Okuno,1 Koji Yanaka,1 Masaaki Uematsu1 1 Kansai Rosai Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. M.H Relevant clinical history and physical exam. 80-year-old man had been implanted Bare-metal stent (Easy Wall 8.050 mm, 8.070 mm) in the severe stenosis of right superficial femoral artery (SFA) 13 years ago. Self-expanding nitinol stent (Luminexx 8.040 mm) had been implanted in in-stent restenosis (ISR) of Easy Wall with overlapping the proximal edge 11 months after Easy Wall implantation. However, because of the recurrence of intermittent claudication 141 months after Luminexx implantation, he was admitted to our hospital. Relevant test results prior to catheterization. Right-ABI was 0.83 and leftABI was 1.08. Duplex ultrasonography demonstrated the stenosis in right popliteal artery. Relevant catheterization findings. Aortography showed 90% stenosis in in Luminexx site and Easy Wall site, and floating stent fracture was detected in Luminexx site by fluoroscopy.
S372
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. First of all, we performed balloon angioplasty in ISR lesion. Under 3 Fr guiding catheter (ParentPlus, 95 cm) support, antegrade wiring with0.014 inch Cruise passed the ISR lesion. We dilated with MUSTANG5.080 mm balloon and angiography showed adequate expansion. Next, we tried to remove the stent strut separated by Luminexx stent. We advanced 3 Fr guiding catheter to the distal PTA. Although we successfully caught the stent strut by EN Snare catheter (2-4 mm, 175 cm), because the size of stent strut was large compared to guiding catheter, the stent strut could not be pulled back to the guiding catheter. We changed 3 Fr guiding catheter to 5 Fr guiding catheter(Destination, 90 cm). Finally, we succeed to pull back the stent strut to the guiding catheter and remove it by EN Snare catheter.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S373
Relevant catheterization findings. First venography: total occlusion from left common iliac vein.
Case Summary. We experienced a case complicated with incidence of floating stent fracture 141months after Luminexxnitinol stent implantation in the SFA. To the best of ourknowledge, there is no report about floating stent fracture in the very latephase as shown this case. It is possible that fractured stent strut can beseparated completely by slight force as this case, and stent strut may causedistal embolus. Therefore, it is important to avoid an unnecessary stentimplantation and close follow-up is necessary for patients with stentimplantation. TCTAP C-223 Catheter-directed Thrombolysis, Iliac and Common Femoral Vein Stenting in May-thurner Syndrome with Refractory Deep Vein Thrombosis Chiung-Ray Lu,1 Ke Wei Chen1 1 China Medical University Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. WCD Relevant clinical history and physical exam. 73-year-old female presented with progressive left leg swelling for one month. Deep vein thrombosis(DVT), from left comon iliac to popliteal veins, was confirmed by computed tomography(CT). Heparinization was given for a week but the peipheral echo revealed no revascularization of DVT. Inferior vena cava(IVC) filter implantation and catheter-directed throbolysis(CDT) was arranged. However refractory thrombosis and re-occlusion was noted despite repeated CDT and aggressive anticoagulation. Relevant test results prior to catheterization. Peripheral echo: severe DVT, left leg without recanalization
S371
After continuous CDT for 9 days, venography showed restoration of blood flow, which was not sufficient. IVUS revealed massive residual thrombus. We decided to add surgicalthrombectomy. The Cardiovascular surgeons removed as much thrombus as possible by 4Fr Fogarty catheter. After removal of thrombus, we noticed the sufficient blood back flow. A 4Fr catheter was inserted into the AVF at the skin incision site and a 0.014 wire was passed to the SCV. IVUS revealed significant narrowing in the SCV through the proximal cephalic vein due to intimal hyperplasia with residual thrombus. Because of clinical history of frequent recurrence, we put a Smart stent 8 / 80 mm (Cordis, CA, the US) to cover the SCV to the proximal cephalic vein, followed by 5 mm balloon dilatation. Final angiogram revealed excellent antegrade blood flow with minimal residual stenosis. Her AVF remained open under oral anticoagulation.
Case Summary. We reported the case with successful restoration of blood flow in the AVF using combination with CDT, surgical thrombectomy and stent implantation in the central vein after 3 weeks of total thrombotic occlusion. In general, once AVF became obstructed with massive thrombus, we give up restoring the blood flow. We could say that CDT might be worth trying for relatively aged thrombus. For young HD patient, durability of AVF is a crucial issue. Therefore, we expect stent implantation may help prolong the life of AVF, though we need to carefully access the patency of stent in this portion. We concluded that hybrid therapy should be considered when we treat this kind of complicated case. TCTAP C-222 Incidence of Floating Stent Fracture 141 Months After Luminexx Nitinol Stent Implantation in the Superficial Femoral Artery Takuya Tsujimura,1 Osamu Iida,1 Shin Okamoto,1 Takayuki Ishihara,1 Kiyonori Nanto,1 Tatsuya Shiraki,1 Shota Okuno,1 Koji Yanaka,1 Masaaki Uematsu1 1 Kansai Rosai Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. M.H Relevant clinical history and physical exam. 80-year-old man had been implanted Bare-metal stent (Easy Wall 8.050 mm, 8.070 mm) in the severe stenosis of right superficial femoral artery (SFA) 13 years ago. Self-expanding nitinol stent (Luminexx 8.040 mm) had been implanted in in-stent restenosis (ISR) of Easy Wall with overlapping the proximal edge 11 months after Easy Wall implantation. However, because of the recurrence of intermittent claudication 141 months after Luminexx implantation, he was admitted to our hospital. Relevant test results prior to catheterization. Right-ABI was 0.83 and leftABI was 1.08. Duplex ultrasonography demonstrated the stenosis in right popliteal artery. Relevant catheterization findings. Aortography showed 90% stenosis in in Luminexx site and Easy Wall site, and floating stent fracture was detected in Luminexx site by fluoroscopy.
S372
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
[INTERVENTIONAL MANAGEMENT] Procedural step. First of all, we performed balloon angioplasty in ISR lesion. Under 3 Fr guiding catheter (ParentPlus, 95 cm) support, antegrade wiring with0.014 inch Cruise passed the ISR lesion. We dilated with MUSTANG5.080 mm balloon and angiography showed adequate expansion. Next, we tried to remove the stent strut separated by Luminexx stent. We advanced 3 Fr guiding catheter to the distal PTA. Although we successfully caught the stent strut by EN Snare catheter (2-4 mm, 175 cm), because the size of stent strut was large compared to guiding catheter, the stent strut could not be pulled back to the guiding catheter. We changed 3 Fr guiding catheter to 5 Fr guiding catheter(Destination, 90 cm). Finally, we succeed to pull back the stent strut to the guiding catheter and remove it by EN Snare catheter.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S373
Relevant catheterization findings. First venography: total occlusion from left common iliac vein.
Case Summary. We experienced a case complicated with incidence of floating stent fracture 141months after Luminexxnitinol stent implantation in the SFA. To the best of ourknowledge, there is no report about floating stent fracture in the very latephase as shown this case. It is possible that fractured stent strut can beseparated completely by slight force as this case, and stent strut may causedistal embolus. Therefore, it is important to avoid an unnecessary stentimplantation and close follow-up is necessary for patients with stentimplantation. TCTAP C-223 Catheter-directed Thrombolysis, Iliac and Common Femoral Vein Stenting in May-thurner Syndrome with Refractory Deep Vein Thrombosis Chiung-Ray Lu,1 Ke Wei Chen1 1 China Medical University Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. WCD Relevant clinical history and physical exam. 73-year-old female presented with progressive left leg swelling for one month. Deep vein thrombosis(DVT), from left comon iliac to popliteal veins, was confirmed by computed tomography(CT). Heparinization was given for a week but the peipheral echo revealed no revascularization of DVT. Inferior vena cava(IVC) filter implantation and catheter-directed throbolysis(CDT) was arranged. However refractory thrombosis and re-occlusion was noted despite repeated CDT and aggressive anticoagulation. Relevant test results prior to catheterization. Peripheral echo: severe DVT, left leg without recanalization