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Shekiladze N, Sandesara PB, Tai Z, Maisuradze N, Jaber W, Nicholson W. Technical aspects of entrapped coronary guidewire retrieval using rotational atherectomy device: A case series. Catheter Cardiovasc Interv 2024; 103:89-96. [PMID: 38071427 DOI: 10.1002/ccd.30923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure. CASE SUMMARY Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires. DISCUSSION Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
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Affiliation(s)
- Nikoloz Shekiladze
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pratik B Sandesara
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zaheed Tai
- Division of Cardiology, Winter Haven Hospital, Winter Haven, Florida, USA
| | - Nodar Maisuradze
- Division of Cardiology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Wissam Jaber
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William Nicholson
- Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Li C, Chen Z, Wang M. Retrieving entrapped guidewire using rotablation technique: case series and literature review. Eur Heart J Case Rep 2022; 6:ytac261. [PMID: 35815312 PMCID: PMC9263157 DOI: 10.1093/ehjcr/ytac261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/04/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
Background The present article summarizes three cases of retrieving entrapped guidewire using rotablation technique. Case summary All three cases pertained to guidewire being fractured and entrapped during percutaneous coronary interventions (PCIs) for right coronary artery (RCA) chronic total occlusion in a local hospital. In Case 1, two fractured filaments connecting to the entrapped guidewire could be clearly seen. One filament was in the right brachial artery and the other one was in the ascending aorta. In Case 2, the operator applied buddy wire technique during PCI but forgot to withdraw the second wire before stenting. As a result, the second SION wire was entrapped by the stent and was untangled and fractured when being retrieved. In Case 3, a SION guidewire was entrapped during PCI for RCA. The initial attempt to retrieve the guidewire ended in failure. Although the entrapped guidewire was still intact, it was difficult to advance the floppy rotawire into the RCA as it was still totally occluded. In those scenarios, complete retrieval of the entrapped guidewire using catheter-based technique was hardly possible. Rotablation was used to cut the entrapped guidewire, retrieve the broken end, and leave the remnants in coronary artery jailed by the stent. Clinical and angiographic follow-up observation demonstrated that the patients were free of target vessel failure. Discussion Entrapment of guidewire is a rare complication of PCI. The management of entrapped guidewire is usually challenging. Rotablation technique is a useful and efficient strategy when conventional methods failed to retrieve the entrapped guidewire.
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Affiliation(s)
- Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, China
| | - Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, China
| | - Mian Wang
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, China
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Wire Cutting Method Using Rotational Atherectomy for Stretched Spring Wire During Coronary Intervention. JACC Case Rep 2021; 3:1842-1848. [PMID: 34917965 PMCID: PMC8642729 DOI: 10.1016/j.jaccas.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
During removal of an entrapped guidewire, the core wire can fracture, allowing stretching of the spring wire while the distal guidewire is still entrapped. We resolved this issue with rotational atherectomy, allowing cutting of the spring wire at the intended site, regardless of the proximal spring wire fracture. (Level of Difficulty: Advanced.)
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Gasparini GL, Sanz-Sanchez J, Regazzoli D, Boccuzzi G, Oreglia J, Gagnor A, Mazzarotto P, Belli G, Garbo R. Device entrapment during percutaneous coronary intervention of chronic total occlusions: incidence and management strategies. EUROINTERVENTION 2021; 17:212-219. [PMID: 32894229 PMCID: PMC9724869 DOI: 10.4244/eij-d-20-00781] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Equipment delivery in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging and it is associated with a higher risk of device entrapment. Data regarding the incidence of device entrapment during CTO PCI are lacking. AIMS The aim of this study was to describe the incidence and procedural characteristics of device entrapment in patients undergoing PCI for CTOs and discuss management strategies for dealing with it. METHODS Device entrapment was characterised in a large consecutive series of 2,361 CTO PCI cases performed by five high-volume CTO Italian operators between January 2015 and January 2020. RESULTS Device entrapment occurred in 36 out of 2,361 cases (1.5%) and consisted of coronary guidewires in 13 (0.5%), microcatheters in 6 (0.2%), balloons in 6 (0.2%), rotational atherectomy burrs in 10 (0.4%) and guiding catheter extension in 1 patient (0.04%). Complete device retrieval was achieved in 63.9%, with at least partial removal of material in 97.2%. Vessel recanalisation was still possible in 86.1% of cases even after device entrapment. Intraprocedural myocardial infarction occurred in 3 patients (8.3%), tamponade with urgent pericardiocentesis in 1 (2.8%) and emergency surgical removal of the entrapped device in 1 patient (2.8%). Mean radiation dose was 4.7±2.3 Gy. At 30-day follow-up, one patient died with stent thrombosis of a non-target vessel and another required repeat percutaneous revascularisation. CONCLUSIONS Device entrapment during CTO revascularisations is a rare but potentially severe complication. We describe and discuss current techniques of percutaneous retrieval that can be employed to achieve procedural success safely.
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Affiliation(s)
- Gabriele-Luigi Gasparini
- Department of Invasive Cardiology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Italy
| | | | | | | | | | | | | | - Guido Belli
- Ospedale Moriggia-Pelascini, Gravedona (CO), Italy
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Benton S, Nicholson WJ. When Things Get Stuck: Gear Entrapment and Other Complications of Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2020; 10:131-145. [PMID: 33223102 DOI: 10.1016/j.iccl.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complex coronary artery intervention stresses the limits of both the operator's skills as well as the equipment being used for the procedure. This article is focused on avoiding, recognizing and dealing with device failure and gear entrapment during complex coronary intervention. The operator must understand how to avoid these complications by understanding the limits of devices and the need for adequate vessel preparation. This article focuses on giving the reader an algorithmic approach to recognizing when device failure/entrapment occurs and what specific maneuvers can be done to retrieve different devices and equipment safely.
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Affiliation(s)
- Stewart Benton
- Interventional Cardiology, Wellspan York Hospital, 25 Monument Road, Suite 200, York, PA 17403, USA
| | - William J Nicholson
- Interventional Cardiology, Complex Coronary and Cardiac Intervention, Emory University, Suite F606, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Su Q, Ding X, Dong Z, Liu Y, Li G, Jiang J. A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil. Int Heart J 2019; 60:93-99. [PMID: 30518716 DOI: 10.1536/ihj.18-075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.
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Affiliation(s)
- Qingbo Su
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Zhaoru Dong
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Yang Liu
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Guangzhen Li
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital of Shandong University
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