How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report

Kassimis, George; Ziakas, Antonios; Didagelos, Matthaios; Θεοδωρόπουλος, Κωνσταντίνος; Hadjimiltiades, Stavros

doi:10.1016/j.carrev.2021.05.007

Cited by 2 publications

(3 citation statements)

References 28 publications

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“…The rotational atherectomy technique, academically termed stent ablation, has been used to resolve this complication. However, this strategy runs the potential risk of burr entrapment within the stent, which requires specific techniques aimed to retrieve the device trapping [ 17 , 18 ]. Cui et al [ 5 ] described an elegant method for the use of stent ablation with a rotablator guided by IVUS and based on the burr size selection principle of ‘downsize first and upsize last’.…”

Section: Discussionmentioning

confidence: 99%

Coronary laser with simultaneous contrast injection for the treatment of stent underexpansion

Mohandes,

Pernigotti,

Moreno

et al. 2024

Cardiol J.

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Background Stent underexpansion is a challenge in interventional cardiology. Some off-label treatments, such as rotational atherectomy, intravascular lithotripsy and coronary lasing, have been used to overcome the problem. The purpose of this study is to evaluate the safety and efficacy of coronary laser atherectomy with simultaneous contrast injection and subsequent balloon dilation to optimize stent expansion. Methods Coronary laser atherectomy with simultaneous contrast injection was used. After lasing, non-compliant balloon dilation at high pressure was performed to overcome the underexpanded point. The average increase in the minimum stent area (MSA) was measured by intravascular ultrasound (IVUS), and any complication related to the technique was evaluated. Additionally, major adverse cardiovascular events (MACE), consisting of death from any cause, new myocardial infarction (MI) and target lesion revascularization, were scrutinized in a long-term follow-up. Results Sixteen underexpanded stents were treated with laser between August 2017 and November 2022. In all cases but one, IVUS was used to evaluate the MSA before and after lasing. The MSA showed an average increase of 2.34 ± 1.57 mm 2 (95% confidence interval [CI]: 1.47–3.21; p < 0.001) after laser application and balloon inflation. No complication related to the technique was detected. During a follow-up period of a median (interquartile range) of 457 (50–973) days, the combined MACE assessed by Kaplan-Meier estimator showed an event-free rate of 0.82 (95% CI: 0.59–1). Conclusions Coronary laser with simultaneous contrast injection is a safe method to optimize a stent underexpansion, with an acceptable event-free rate in long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Coronary laser with simultaneous contrast injection for the treatment of stent underexpansion

Mohandes,

Pernigotti,

Moreno

et al. 2024

Cardiol J.

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“…In the field of PCI, a double guide catheter technique has been reported as a bailout strategy for entrapped devices [3,4,[6][7][8]. This strategy enables the utilization of new devices, such as guidewires, catheters, and balloons, via a second guide sheath and can enable retrieval of entrapped devices.…”

Section: Discussionmentioning

confidence: 99%

“…Entrapment of devices, such as a Rota bar, an extension catheter, or an intravascular ultrasound device, during percutaneous coronary intervention (PCI) has been reported [1] and bailout strategies have been discussed [2][3][4]. However, there have been few reports about managing the entrapment of devices during endovascular treatment (EVT).…”

Section: Introductionmentioning

confidence: 99%

Successful Removal of an Entrapped Stent Delivery Catheter Using Two Arterial Sheaths in the Ipsilateral Groin

Miyauchi,

Arikawa,

Tokutake

et al. 2023

Cureus

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Entrapment of devices, such as a Rota bar, an extension catheter, or an intravascular ultrasound device, during percutaneous coronary intervention has been reported and bailout strategies have been discussed. However, there have been few reports on entrapment of devices during endovascular treatment (EVT). A 70year-old man was referred to our clinic for the management of rest pain in his left lower limb. His left anklebrachial index was unmeasurable and computed tomography angiography revealed total occlusion of the left common, external iliac, and superficial femoral arteries (SFA). He was diagnosed as having symptomatic limb-threatening ischemia and EVT was planned. The first EVT was performed on an occluding lesion in the left iliac artery. We used a transradial approach and deployed two bare nitinol stents in the left iliac artery without complications. One week after the first EVT, the second EVT was performed on an occluding lesion in the left SFA. A 6.0-French (Fr) guide sheath was inserted antegradely through the left common femoral artery. The occluded lesion was dilated with a 4.0 mm plain balloon, following which intravascular ultrasound revealed a localized severe stenotic lesion in the distal part of the SFA. A 6.0 mm drug-eluting stent was deployed to cover the stenotic lesion in the distal part of the SFA without pre-dilation; however, the stenotic lesion did not dilate sufficiently. When we attempted to extract the stent delivery catheter, we could not detach its tip from the localized severe stenotic lesion and were unable to remove it by force or external compression. Therefore, we decided to implement a double guide technique by inserting a 4.0-Fr sheath simultaneously into the left common femoral artery adjacent to the first puncture site together with another 0.014-inch guidewire via a 4.0-Fr sheath to get past the lesion in which the catheter tip was embedded. We then used a 3.0-mm plain balloon to dilate the severe stenotic lesion sufficiently to enable the removal of the stent delivery catheter. Another 6.0-mm drug-eluting stent was then deployed, after the first stent, to cover the occluded lesion in the middle part of the SFA. Hemostasis was safely achieved at both puncture sites by manual compression. A double guide technique, as in percutaneous coronary intervention, is useful for the bailout of an entrapped device during EVT. Careful consideration of the access site and size and length of the second guide sheath are necessary.

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How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report

Cited by 2 publications

References 28 publications

Coronary laser with simultaneous contrast injection for the treatment of stent underexpansion

Coronary laser with simultaneous contrast injection for the treatment of stent underexpansion

Successful Removal of an Entrapped Stent Delivery Catheter Using Two Arterial Sheaths in the Ipsilateral Groin

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