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Address for correspondence: Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Neihu Rd., Neihu Dist., Taipei City, 11464, Taiwan

Division of Cardiology Department of Internal Medicine Taoyuan Armed Forces General Hospital Taoyuan County, Taiwan

You can find me at:shangz0216@gmail.comI am Guo-Shiang Tseng, MDHello!

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TCTAP 2016 C-123

Inadvertent Extraction of a Drug Eluting Stent with a Thrombus Aspiration Catheter During Primary Percutaneous Coronary Intervention

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An entrapped thrombus aspiration catheter (TAC) with the deployed stent is uncommon, but one of the nightmare complications in the cardiac cath lab.Henry Fuseli, 1781

The Nightmare

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Case BriefingRisk facrors: Cigarette smokingDiabetesHyperlipidemia

Mr. Zhang, 45-year-old male smokerOngoing angina pectoris for the last 4 hoursHR: 53/min, BP: 76/56 mmHgECG and UCG: acute inferior wall STEMI

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Cardiac Catheterization FindingsRCA: Total occlusion of the M/3

LM: PatentLAD: Luminal irregularityLCx: 50% stenosis of the M/3

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Interventional ManagementJR 3.5 (7.0Fr)SION wireThrombuster II

(Model No.: T2R6SA4W)

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Interventional ManagementTIMI 2 flowRewiring & 2nd ThromboaspirationEntrapped

Grade 1 thrombus !?

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Interventional Management

Rescue GW(SION)Balloon !?En-bloc retrieval

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Interventional Management

Type CDissectionTIMI 2 flowStent & Final

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EntrapmentWhy?

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Extracted stent

Rescue SIONExtra-Support

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Extracted stent

Thrombuster II-6Fr(T2R6SA4W)

1.7mm10mm

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Dismantling

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Mechanism of EntrapmentAbnormal resistance

Shortened wire lumen length of TAC

Improved flexibility and trackabilityVulnerable part to breakArterial tortuosityUnder-deployed stentInadequate route of the guidewire

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Animation of the procedural complication

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Maintain original guidewire positionKnuckle-wire techniquePay respect to the resistance during device deliveryLengthened wire lumen of TAC

Take-Home Message

Circ Cardiovasc Interv. 2015 Feb;8(2)J Invasive Cardiol. 2011 Jul;23(7)

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Thanks! Any questions?You can find me at:shangz0216@gmail.com

Acknowledgments: I wish to acknowledge and thank Dr. Wei-Shiang Lin and Jun-Ting Liou for providing information and advice during preparation of the oral presentation.

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Life is an Adventure

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Dare to dream

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