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Background Our case demonstrates a novel use of the Sentinel™ cerebral protection device (SCPD) for prevention of stroke during removal of a thrombus‐adherent atrial septal occluder. Case Presentation A 45‐year‐old male with multiple strokes and ostium secundum atrial septal defect closed ten years prior using an Amplatzer Septal Occluder presented with recurrent neurologic symptoms. Over the ensuing year, serial transesophageal echocardiography revealed persistent and worsening device‐adherent thrombus despite trial of different anticoagulants. The device appeared to be mal‐deployed, prompting the decision for surgical explant. Given concern for embolization during explant, an SCPD was placed. Excision, pericardial patch repair, and Atriclip appendage closure (AAC) were performed. The device demonstrated incomplete endothelialization and microthrombi. SCPD filtration revealed embolic debris. Conclusions We demonstrate the first successful use of an SCPD during surgical excision of a mal‐deployed occluder. With its ease of use and safety, SCPD may have utility in surgeries with high cardio‐embolic risk.

INTRODUCTION: Coronary guidewire entrapment and fragmentation during percutaneous coronary intervention is an infrequent complication with incidence between 0.1-0.2%. The retained fragment can lead to flow impediment, vessel thrombosis, distal embolism, and vessel perforation. Complications of guidewire retrieval include developing cardiac tamponade and requiring emergent cardiac surgery. We present a young male with severe multi-vessel disease and a rare procedural complication of coronary guidewire entrapment and fragmentation during percutaneous coronary intervention.

Introduction Clostridium species are gram-positive or gram-variable anaerobic organisms that have been known to cause different kinds of infections of varying scope and severity. Clostridium species have been associated with high in-hospital mortality rates, particularly in immunocompromised patients with malignancies. Despite the potential severity of these infections in the oncologic population, primary literature on the topic is relatively scarce. Methods A retrospective chart review was performed to identify all patients older than 18 years with positive Clostridium species blood cultures at the H. Lee Moffitt Cancer Center and Research Institute from April 10, 2005, to September 30, 2016. Data were analyzed to identify underlying risk factors, clinical presentation, and treatment of Clostridium bacteremia in the cancer population. Results A total of 18 patients had bacteremia with Clostridium species. The patients' ages ranged from 26 to 79 years (median, 62.5 years), and 6 of the patients were female (33%). The predominant Clostridium species in our sample was Clostridium perfringens, which was found in 7 patients (38%), followed by Clostridium septicum found in 4 patients (22%). A gastrointestinal source was identified in 11 patients (66%). Three patients died of the infection (16%). Conclusions The potential severity of Clostridium infections in the oncologic population warrants a thorough evaluation in every patient with positive blood cultures, with focus on the gastrointestinal tract as a potential source of infection. Further studies about susceptibility testing would provide valuable information and may serve to reduce mortality rates among patients with Clostridium bacteremia.