Lots of interesting abstracts and cases were submitted for TCTAP 2023. 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-110
The Struggle of Retrieving a Repeatedly Dislodged Stent
By Deddy Hermawan Susanto, Audie Christopher, Riyandi Ardi Putra Fernandes, Hardi Hutabarat, Sonia Chandra, Antonia Anna Lukito
Presenter
Audie Christopher
Authors
Deddy Hermawan Susanto1, Audie Christopher1, Riyandi Ardi Putra Fernandes1, Hardi Hutabarat1, Sonia Chandra1, Antonia Anna Lukito1
Affiliation
Siloam Hospitals Lippo Village, Indonesia1,
View Study Report
TCTAP C-110
CORONARY - Complications (Coronary)
The Struggle of Retrieving a Repeatedly Dislodged Stent
Deddy Hermawan Susanto1, Audie Christopher1, Riyandi Ardi Putra Fernandes1, Hardi Hutabarat1, Sonia Chandra1, Antonia Anna Lukito1
Siloam Hospitals Lippo Village, Indonesia1,
Clinical Information
Patient initials or Identifier Number
Mr. DR
Relevant Clinical History and Physical Exam
A 42 years-old male came to the clinic with recurring crushing chest pain that worsened with activity and relieved by rest. He has undergone coronary arteriography 2 months prior due to Anterior MCI and was found to have a total occlusion in the LAD and significant stenosis in LCx. Primary PCI was done in the LAD and now we are planning to open the LCx. Upon coronary arteriography, we found that the stent placed two months prior was still patent.
Relevant Test Results Prior to Catheterization
Relevant Catheterization Findings
Interventional Management
Procedural Step
The procedure was done via right radial artery by using Asahi Sion Blue guidewire through Falcon XBU 3.5/6F guiding catheter and passing through target lesion at mid LCx. Pre-dilatation using Scoreflex balloon 2.0 x 15 mm inflated to 14-16 atm, and followed by the attempt to insert the Supraflex Cruz DES 4.5 x 24 mm to mid LCX but unexpectedly the guiding catheter jumped out. When pulling back, resistance was felt and we noticed the stent was deformed.
The attempt to retrieve the dislodged stent using Sapphire II Pro 1.0 x 10 mm balloon failed. On second thought, the same balloon was used to pinch the tip of the stent while attempting to pull out the whole system including guiding catheter, unfortunately the stent slipped out and dislodged in the right brachial artery. Then effort was made to snare the stent using hand-made looped guidewire-pressed-by-a-10 atm-balloon-inside-a-6F-JR guiding catheter, but the stent accidentally flew to the right ulnar artery. Despite these unfortunate events, the relentless effort was continued by making new access retrogradely through right upper brachial artery aimed to use goose-neck catheter to snare the dislodged stent, and eventually we successfully pulled out the deformed stent.
The mid LCX was stented with Combo Plus DES 4.0 x 33 mm without any difficulty
The attempt to retrieve the dislodged stent using Sapphire II Pro 1.0 x 10 mm balloon failed. On second thought, the same balloon was used to pinch the tip of the stent while attempting to pull out the whole system including guiding catheter, unfortunately the stent slipped out and dislodged in the right brachial artery. Then effort was made to snare the stent using hand-made looped guidewire-pressed-by-a-10 atm-balloon-inside-a-6F-JR guiding catheter, but the stent accidentally flew to the right ulnar artery. Despite these unfortunate events, the relentless effort was continued by making new access retrogradely through right upper brachial artery aimed to use goose-neck catheter to snare the dislodged stent, and eventually we successfully pulled out the deformed stent.
The mid LCX was stented with Combo Plus DES 4.0 x 33 mm without any difficulty
Case Summary
This case depicts the struggle of overcoming a repeatedly dislodged stent and the never-give-up mentality to solve the complication. When something did not go as planned, one should stay calm and resort to other ways of overcoming it.