A novel double snare technique to retrieve embolized septal and left atrial appendage occluders

Transcatheter retrieval of atrial septal defect and patent ductus arteriosus occluder: a guidance for device retrieval based on comprehensive bench tests

OBJECTIVES

The aim of this study is to establish a guidance for device retrieval based on comprehensive bench tests.

BACKGROUND

Device embolisation remains a major complication in transcatheter closure of atrial septal defect and patent ductus arteriosus. Although percutaneous retrieval is feasible in the majority of cases, surgical retrieval may be required in complicated circumstances. However, the methods of transcatheter device retrieval have not been completely established.

METHODS

Bench tests of device retrieval were performed to verify the appropriate retrieval method according to device type/size. The devices used for testing were Amplatzer Septal Occluder (Abbott, Chicago, IL, United States of America), Figulla Flex II (Occlutech GmbH, Jena, Germany), Amplatzer Duct Occluder-I (Abbott), Amplatzer Duct Occluder-II (Abbott), and Amplatzer Vascular Plug-II (Abbott). The retrieval equipment constituted diagnostic catheters (multipurpose catheter and right Judkins catheter, 4-Fr or 5-Fr, Gadelius Medical, Tokyo, Japan), delivery sheath and cables for each device, Amplatz goose neck snares (Medtronic, Minneapolis, MN, United States of America), OSYPKA CATCHER (Osypka ag, Rheinfelden-Herten, Germany), and OSYPKA LASSOS (Osypka). We investigated the retrieval equipment and sheath sizes required for a successful retrieval procedure for variously sized devices.

RESULTS

For patent ductus arteriosus devices, the type of snare and the snaring position are considered important. For atrial septal defect devices, simple snare capture or a double-snare technique with a sufficiently large sheath is effective. Special care should be taken when using the OSYPKA CATCHER for device retrieval.

CONCLUSIONS

The results of this study may assist in the selection of both capture devices and a retrieval sheath or a catheter for complete retrieval.

Successful retrieval of embolised Occlutech atrial septal defect occluder from descending aorta in a 4-year-old child using a "mother and child" technique: a case report and literature review

A 9 mm Occlutech septal occluder Flex II device was retrieved in a 4-year-old 22 kg child; A 6 Fr Cook® Flexor sheath (child) was inserted into a 9 Fr Occlutech® ASD Delivery Set (mother). Once the tip of the smaller sheath was close to the device, a 4 Fr right Judkins catheter was introduced with a snare. The right atrial hub was captured and withdrawn to the level of the 6 Fr sheath which was then withdrawn into the 9 Fr sheath before being removed completely. The "mother and child" technique offers a greater likelihood of slenderising and retrieving embolised devices.

A pilot with a helicopter in the left atrium: a case report of an embolized Watchman device

Background

Embolization of a Watchman device in patients undergoing percutaneous left atrial appendage (LAA) closure is a rare complication. Retrieval of the device can be achieved percutaneously with a snaring technique or a bioptome.

Case summary

We present an illustrative case of Watchman closure device embolization during an LAA closure attempt in a 77-year-old man. The complication was caused by anatomical restraints of the LAA, in particular limited depth resulting in poor stability of the closure device after implantation. By the use of a double snaring technique, however, we managed to retrieve the device percutaneously. By applying such strategy, a more invasive surgical approach can be prevented.

Discussion

Prompt response is needed when embolization of a Watchman device occurs. A snaring technique can be used in most cases to attempt device retrieval. A double snaring technique is in this case associated with higher retrieval success than a single snaring technique.

Technical aspects of a successful transvascular retrieval of an acutely dislodged WaveCrest® left atrial appendage occluder

Percutaneous left atrial appendage (LAA) closure is an alternative therapy in patients with atrial fibrillation who are not suitable for anticoagulation. However, device embolization is one of the notable complications which inevitably requires catheter or surgical retrieval. In addition to previously reported Watchman® or AMULET® occluder embolization, here we report the first case of a WaveCrest® occluder dislodgement which was successfully removed by transcatheter technique. Instead of using the well-known snaring technique, we used a "wiring and ballooning technique" for retrieval. Considering its specific architecture without having hooks or feet where suitable for grasping, this technique is an option for retrieving WaveCrest® devices.