Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-105
Nightmare In Cathlab- When Simple Case Turns to Complex by Tearing Off the Stent Delivery System Shaft
By Azfar Hossain Bhuiyan, Shahab Uddin Talukder
Presenter
Azfar Hossain Bhuiyan
Authors
Azfar Hossain Bhuiyan1, Shahab Uddin Talukder1
Affiliation
Evercare Hospital Dhaka, Bangladesh1,
View Study Report
TCTAP C-105
CORONARY - Complications
Nightmare In Cathlab- When Simple Case Turns to Complex by Tearing Off the Stent Delivery System Shaft
Azfar Hossain Bhuiyan1, Shahab Uddin Talukder1
Evercare Hospital Dhaka, Bangladesh1,
Clinical Information
Patient initials or Identifier Number
Mr. AL
Relevant Clinical History and Physical Exam
59 yrs old gentleman. CAD risk factors: Hypertension, Diabetes Mellitus, Dyslipidaemia, Positive Family history of CAD.
Admitted with Acute Anterior MI & got Tenecteplase.
Relevant Test Results Prior to Catheterization
Troponin-I: >50000 ng/L, ECG: ST Elevation in V1-V6, Echo: Anterior wall is hypokinetic with Mild LV systolic dysfunction (EF- 45%). Hb-14.2 gm/dl, Creatinine: 1.12 mg/dl, Na- 135, K- 4.0, Cl- 100 m mol/L, Plasma BNP: 235 pg/ml, Covid19 RT-PCR- Negative, S. Bilirubin- 0.3 mg/dl, ALT- 45 IU/L, AST- 107 IU/L, Anti-HCV- Negative, Anti-HIV- Negative, HbsAg- Negative,
Relevant Catheterization Findings
LMCA: Normal.
LAD: Got 90-99% narrowing in its proximal segment followed by 90-99% diffuse disease. DG1 is small and diseased. DG2 has got sub-total occlusion at its origin.
LCX: Good size artery with mild ostial narrowing & 50% narrowing in its mid segment. Principal OM has got 50% narrowing in its ostium.
RCA: Dominant artery has got 60% narrowing in its proximal segment. PDA is a good size artery & got mild irregular narrowing in its proximal segment.
Recommendation: PCI to LAD
SYED ABDUL LATIF_ 59YRS_(S1_F1-58)(1).wmv SYED ABDUL LATIF_ 59YRS_(S4_F1-61).avi SYED ABDUL LATIF_ 59YRS_(S6_F1-56).aviInterventional Management
Procedural Step
Procedure Details: LCA was engaged with guiding catheter EBU -3.5 (6F). Sion Blue wire crossed the lesion of LAD, another wire crossed the lesion of Diagonal branch and pre-dilatation was done with 2.0 x 15 mm balloon at 08-10 ATM. Proximal lesion was stented with a 2.75 mm x 18 mm stent(Xience Alpine) at 12-14 ATM. After withdrawing the wire following angiogram showed proximal LAD was well dilated but mid LAD having a long dissection which interrupted the distal flow. So, decided to put stent in mid LAD. Again repeated ballooning was done in mid LAD to prepare the lesion and a 2.25 mm x 28 mm stent (Xience Xpedition)was taken for mid LAD but stent didn't cross the mid LAD lesion. During stent withdrawal it was struck in the previous Proximal stent and proximal calcified segment. When trying to pull it back, the delivery system shaft was tear off. Tried to get the shaft by coronary snare but failed to get it back. Finally he was recommended to retrieve the torn delivery system & stent surgically.
SYED ABDUL LATIF_ 59YRS_(S33_F1-74).avi
SYED ABDUL LATIF_ 59YRS_(S47_F1-150).avi
IMG-2009(1).MOV
SYED ABDUL LATIF_ 59YRS_(S33_F1-74).avi SYED ABDUL LATIF_ 59YRS_(S47_F1-150).avi IMG-2009(1).MOVCase Summary
Conclusion:~ Stent with torn delivery system entrapment might not be rare.
~ In this situation, emergency decision to tackle the situation and Bail out decision to send the patient for surgical retrieval of the delivery system & stent saved the life of the patient.Take Home Message:~ No case is simple in Intervention.~ Preparedness to tackle any untoward consequence is the key to success and save lives.
~ In this situation, emergency decision to tackle the situation and Bail out decision to send the patient for surgical retrieval of the delivery system & stent saved the life of the patient.Take Home Message:~ No case is simple in Intervention.~ Preparedness to tackle any untoward consequence is the key to success and save lives.