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Elbayomi M, Weyand M, Nooh E, Harig F. The lost balloon at midnight: a case report reveals the inevitability of heart team existence. J Cardiothorac Surg 2023; 18:102. [PMID: 37024888 PMCID: PMC10080842 DOI: 10.1186/s13019-023-02202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Dislodgement of a coronary stent-balloon catheter during percutaneous coronary intervention (PCI) is rare but is a life-threatening complication. A 57- year-old male presented with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography revealed total thrombotic occlusion of the Right coronary artery (RCA). Following the balloon dilatation of the RCA and while trying to retrieve the balloon catheter, the balloon was dislodged from the catheter shaft and entrapped in the coronary vessel. Under cardiopulmonary bypass, with antegrade cardioplegic arrest, the balloon was extracted through a coronary arteriotomy. Right coronary revascularization was done with reversed saphenous vein graft (SVG). DISCUSSION Given the variety of equipment that can be retained in the coronary artery and the multitude of mechanisms by which it may be entrapped, there are no straightforward techniques applicable to all situations. Specific guidelines or recommendations on properly managing these potentially life-threatening complications do not exist. However, the most crucial issue in the management of these cases is the hemodynamic status of the patient as well as the coronary flow in the vessel with entrapped device or stent. In our case, the RCA was retrogradely perfused from the left coronary artery, which provided time to transfer the patient to cardiovascular surgical backup.
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Affiliation(s)
- Mohamed Elbayomi
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Michael Weyand
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Ehab Nooh
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Frank Harig
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
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Goerne H, de la Fuente D, Cabrera M, Chaturvedi A, Vargas D, Young PM, Saboo SS, Rajiah P. Imaging Features of Complications after Coronary Interventions and Surgical Procedures. Radiographics 2021; 41:699-719. [PMID: 33798007 DOI: 10.1148/rg.2021200147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary artery interventions and surgical procedures are used in the treatment of coronary artery disease and some congenital heart diseases. Cardiac and noncardiac complications can occur at variable times after these procedures, with the clinical presentation ranging from asymptomatic to devastating symptoms. Invasive coronary angiography is the reference standard modality used in the evaluation of coronary arteries, with intravascular US and optical coherence tomography providing high-resolution information regarding the vessel wall. CT is the mostly commonly used noninvasive imaging modality in the evaluation of coronary artery intervention complications and allows assessment of the stent, lumen of the stent, lumen of the coronary arteries, and extracoronary structures. MRI is limited to the evaluation of the proximal coronary arteries but allows comprehensive evaluation of the myocardium, including ischemia and infarction. The authors review the clinical symptoms and pathophysiologic and imaging features of various complications of coronary artery interventions and surgical procedures. Complications of percutaneous coronary interventions are discussed, including restenosis, thrombosis, dissection of coronary arteries or the aorta, coronary wall rupture or perforation, stent deployment failure, stent fracture, stent infection, stent migration or embolism, and reperfusion injury. Complications of several surgical procedures are reviewed, including coronary artery bypass grafting, coronary artery reimplantation procedure (for anomalous origin from opposite sinuses or the pulmonary artery or as part of surgical procedures such as arterial switching surgery and the Bentall and Cabrol procedures), coronary artery unroofing, and the Takeuchi procedure. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Harold Goerne
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Diego de la Fuente
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Miguel Cabrera
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Abhishek Chaturvedi
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Daniel Vargas
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Phillip M Young
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Sachin S Saboo
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Prabhakar Rajiah
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
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Szczechowicz MP, Mkalaluh S, Torabi S, Zhigalov K, Mashhour A, Karck M, Easo J, Weymann A. Bailout bypass surgery for complications of coronary interventions. Asian Cardiovasc Thorac Ann 2020; 28:205-212. [PMID: 32276539 DOI: 10.1177/0218492320919200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mechanical complications of percutaneous coronary interventions are treated percutaneously in most cases. If the rescue intervention is unsuccessful, bailout bypass surgery is necessary to restore the coronary flow. The surgical risk in these cases is higher than that of patients operated on for other indications. The aim of our study was to characterize patients who underwent surgical treatment at our institution and to compare their long-term outcomes with patients who underwent emergency bypass surgery for other indications. METHODS We analyzed 707 consecutive patients who underwent isolated emergency bypass surgery at our institution from 2007 to 2015. In 44 of these cases, the surgery was necessitated by mechanical complications of percutaneous coronary interventions. There were 31 coronary dissections, 5 entrapped guidewires, and 8 coronary perforations. We compared patients in these three groups with one another. Follow-up was performed to assess long-term outcomes. RESULTS The median age of the cohort was 68 years (range 59-75 years), and 36 (81.8%) patients presented in cardiogenic shock. Thirty-seven (84.1%) patients had history of a percutaneous coronary intervention. The courses were typical for bypass patients. The long-term survival was similar in all three subgroups (p = 0.16). The survival profiles within our sample did not differ significantly from that in patients who underwent emergency bypass surgery for other indications. CONCLUSIONS Surgical risk and short- and long-term outcomes of patients undergoing emergency bypass surgery due to mechanical complications of percutaneous coronary interventions are similar to those of patients receiving the same surgery for other indications.
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Affiliation(s)
- Marcin P Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Saeed Torabi
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Konstantin Zhigalov
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Ahmed Mashhour
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Jerry Easo
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
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Ibrahim KS, Alwaqfi NR, Ibdah RK. Coronary artery bypass as a treatment of stent dislodgement: A case report. Ann Med Surg (Lond) 2019; 47:47-49. [PMID: 31641504 PMCID: PMC6796572 DOI: 10.1016/j.amsu.2019.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction Stent dislodgement is a known complication during coronary angiography. Different methods are used to retrieve it including open heart surgery. Case presentation A 71 year-old male with stable angina was scheduled for elective coronary angiography. Angiography showed two significant stenosis: one in the proximal right coronary artery (RCA) and one in the left anterior descending artery (LAD). Upon deployment of the right coronary stent, it got lodged and the cardiologist was unable to retrieve it. The patient started to experience angina and his ECG showed ST segment elevation in the inferior leads. Emergency CABG was performed. Conclusion Stent dislodgement is a rare but serious complication. Most cases are treated by interventional methods; however, CABG is still needed in some cases. Stent dislodgement is not a common complication of coronary angiogram. Dislodged stents are usually removed by catheterization. Coronary artery bypass surgery CABG is needed if retrieval is not successful.
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Affiliation(s)
- Khalid S Ibrahim
- Division of Cardiac Surgery, Departmrent of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Jordan.,Division of Cardiology, Departmrent of Internal Medicine, College of Medicine, Jordan University of Science and Technology, Jordan
| | - Nizar R Alwaqfi
- Division of Cardiac Surgery, Departmrent of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Jordan.,Division of Cardiology, Departmrent of Internal Medicine, College of Medicine, Jordan University of Science and Technology, Jordan
| | - Rashid K Ibdah
- Division of Cardiology, Departmrent of Internal Medicine, College of Medicine, Jordan University of Science and Technology, Jordan.,Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Jordan
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