Retrieval of Broken Export Catheter during Primary Angioplasty

Management of a broken guiding catheter tip: Cut and fix technique

A 49-year-old male presented with class III exertional angina, 1 year after angioplasty of the left anterior descending artery (LAD) and right coronary artery. Coronary angiogram revealed 90% in-stent restenosis (ISR) in mid-LAD with angiographic impression of stent fracture. Optical coherence tomographic evaluation of mid-LAD ISR showed a distinct 3 mm long "eclipse sign" indicating embolized, broken guiding catheter tip as a cause of ISR, which was confirmed on reviewing 1-year-old angiographic images. This was managed with "cut and fix technique" using cutting balloon and another drug-eluting stent. Optical coherence tomographic at 9 months showed well endothelialized stent with a thin layer of neo-intimal hyperplasia over the sandwiched broken guiding tip.

A Rare Case of Thrombus Aspiration Device Stuck in the Stent

Hardware loss and entrapment during percutaneous coronary intervention is one of the important complications, which an interventionist should anticipate in his practice. Basic knowledge about various extraction methods is essential to bail out in such situations. We describe a 74-year-old male, in whom a used thrombuster device got stuck in struts of an already deployed stent in the right coronary artery. The device could not be retrieved via various percutaneous maneuvers, necessitating an emergency surgical device retrieval and concomitant coronary bypass.

Use of rotablation to rescue a “fractured” micro catheter tip: A case report

BACKGROUND

High-speed rotational atherectomy (HSRA) is most commonly used to modify calcified coronary artery lesions to facilitate stent deployment and expansion. The use of HSRA as an emergency rescue technique to release a fractured micro-catheter has not been described. We report the use of HSRA in a case of a fracture trapped corsair tip that was impeding coronary flow causing a ST elevation myocardial infarct.

CASE SUMMARY

A 79 years old male was scheduled for elective percutaneous coronary intervention (PCI) to his left anterior descending artery (LAD). Given its calcific nature, a decision was made for upfront rotablation. During procedural preparations, the tip of an employed micro-catheter was separated from the shaft resulting in obstructing coronary flow and ST-segment elevation. The consensus was for an attempt bail out PCI strategy. A rotafloppy wire was advanced to the distal LAD using a corsair micro-catheter which was placed proximal to the occlusion site. Modification of the mid LAD segment was performed, resulting in mobilising the corsair tip, and deflecting it to a small diagonal branch. Following serial predilation, the procedure was completed using two overlapping drug eluting stents, jailing the corsair tip in the diagonal branch. The patient made uneventful recovery and was clinically stable at one year follow up.

CONCLUSION

HSRA may be offered as a bailed-out strategy to rescue fractured and jailed micro-catheter tip in high risk surgical cases.

Successful device retrieval using simple balloon method during cardiac procedures

Objectives

Although rare, incidents of broken/dislodged fragment of various angioplasty hardwares, including catheters, guidewires, angioplasty balloons, and stents, are being increasingly reported in recent years. Since these broken fragments may cause life-threatening consequences for a patient, it is vital for an interventional cardiologist to be acquainted with different retrieval techniques. Here, we are reporting our observations of several incidents of device dislodgement/fracture during cardiac interventions and their retrieval using simple balloon method.

Methods

We present a study of eight patients in whom we attempted to retrieve dislodged/fractured cath-lab hardwares during cardiac interventions, using simple balloon method. These cases include two cases of balloon, three cases of stent, and three cases of guidewire dislodgement/fracture.

Results

Fractured/dislodged cath-lab hardwares were successfully retrieved using a simple balloon method in six out of eight cases (75%), without any need of other retrieval hardwares. We observed no major complications in any patient.

Conclusions

The balloon-assisted retrieval method is a simple, safe, and cost-effective way to avoid complications of endothelial injury, myocardial infarction, emergency coronary artery bypass graft, and sudden cardiac death. This study, particularly the context of retrieval technique used in each case, will offer valuable information to fellow interventional cardiologists.

Successful Retrieval of Uncoiled Coronary Guidewire Using Simple Balloon Method

Breakage of angioplasty device in coronary artery can cause panic in the catheterization laboratory. These broken fragments may serve as a nidus for thrombus formation; hence, removal of these fragments becomes mandatory. Since the incidence of guidewire fracture during angioplasty are rarely reported, evidence-based approaches are not available for the management of such incidental conditions. Here, we report an interesting case of entrapment and unravelling of guidewire. We successfully retrieved unravelled guidewire using a noncompliant balloon inflated in the guiding catheter. Subsequently, the procedure was completed successfully with an implantation of a stent in the culprit lesion. We are of opinion that this novel technique is quite easy and less cumbersome than other described techniques reported earlier.

Experimental design approach to the optimization of PAHs bioremediation from artificially contaminated soil: application of variables screening development

BACKGROUND

The effectiveness of bioremediation systems for PAH-contaminated soil may be constrained by physicochemical properties of contaminants and environmental factors. Information on what is the most effective factor in bioremediation process is essential in the decision of what stimulations can be taken to assist the biodegradation efficacy.

METHODS

In this study, four factors of surfactant (Tween 80), humic acid (HA), salinity and nutrients in a 2(4) full factorial design were screened in bioremediation of phenanthrene contaminated soil by using a consortium of bacteria.

RESULTS

Between the employed levels of the factors only salinity had not significant effect. Optimal concentrations of surfactant, HA and nutrient were obtained by a response surface design. For phenanthrene biodegradation, a central composite face centred design (CCFD) showed that nutrient, surfactant and HA concentrations had highly significant, significant and insignificant effects, respectively. The best conditions with 87.1% phenanthrene biodegradation were 150 mg HA/Kg soil, 12.68 μg/L surfactant, and nutrients as K2HPO4, 0.8; KH2PO4, 0.2 and KNO3, 1 g/L. A high similarity was between the model prediction and experimental results.

CONCLUSIONS

This study showed that nutrient with 81.27% efficiency could be considered as the most effective factor for practical implications of bioremediation process for PAHs contaminated soil cleanup strategies.

Retrieval of impacted broken balloon by balloon inflation in guiding catheter

Broken catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication. It can result in serious problems as a result of thrombus formation and embolization of broken fragment. We report an unusual complication of a broken balloon catheter during angioplasty, which was successfully retrieved by balloon inflation in guiding catheter technique.