A. Pichard, MD Director Cath Labs,
Washington Hospital Center Professor of Medicine (Cardiology),
Georgetown University. Washington, DC
Device loss and foreign body retrieval.
Best Strategy
Preventing Device Loss in the CV system is key to a successful practice of CV Intervention.
1) Stents should reach the lesion without any pushing!
2) Septal defects should have “good parameters” for effective closure with a device.
3) Common sense should prevail when closing heart/vascular defects with devices.
IVC filter Strut Fracture + Migration
Patient Year Presentation Location Intervention Reference
47M 2010 Myopericarditis RV free wall
CT Surgery Nathani JIC 2010
31F 2009 Tamponade RV free wall
CTS Kalavakunta JIC 11/09
56F 2009 Tamponade RV free wall
CTS Rogers Circ 2009
40F 2008 Chest pain RV free wall
CTS (offpump)
Kumar JCS 6/08
53M 2008 Tamponade RV CTS Chandra SMJ 11/08
66F 2006 Tamponade RV free wall
CTS Saeed CVIR 4/06
Implantable Port Catheters
• Embolization in 0.2-4.2%
• “Pinch-off Syndrome”:
chronic compression between
clavicle and first rib, with
rupture of the catheter.
• Mostly asymptomatic. Can result in arrhythmia, infection, thromboembolic events, myocardial perforation.
• They should be snared and retrieved.
Embolized Stents
Retrieval Techniques:
• If wire still across: advance small balloon past the stent, inflate and retrieve unexpanded stent.
• Twist 2(3) wires around stent and retrieve.
• Snare the stent
• Crush against the wall with new stent.
Outcome of Embolized or Misplaced Stents. Kozman et al. AJC 2001;88:630-4
23 cases in 4 years, compared to matched group of 23 patients.
Predictors of embolization:
- angulation >45º
- passage through previous stent
Outcome:
- 16/23 in coronary circulation: 8 retrieved. 7 embolized: all had MACE in 36 months.
- 1/8 embolized to peripheral circulation had possible vascular insufficiency.
Embolized Stents. German Registry. Bolte et al. Circ 1999;100:I-233
432 cases of stent embolization.
28% event rate on follow up.
1/210 stents lost in the peripheral circulation had events.
Soutenir Micro Snare. Miyashita et al. J Inv Card 2011;23:E161-3
Goes into a 0.020 lumen microcatheter. Used to retrieve thrombus in the cerebral circulation. Used to pull wire from retrograde access in CTO. Size of the Soutenir basket: 3,5 and 7 mm.
Asahi
Angiovac
for Large Intracardiac Masses
21 F sheath for aspiration cannula. 18F sheath in other vein to re-infuse blood
This patient is a 60-year-old obese male who had recent spine surgery. A large
saddle PE was confirmed with CT scan.
PE removed from filter
Pulmonary Embolism
55 yo with Factor Leiden Deficiency. 3 sternotomies (2
Pulm. Embolectomies, 1 for large RA thrombus)
Conclusions
• Device loss needs to be prevented!.
• Most devices embolized can be retrieved.
• Small devices (wire tips, small stents) produce unlikely to be harmful if left in the vascular system.
• New systems for retrieval of large masses are now available.
• Team approach for creative device retrieval required.