TCTAP oral case presentation at Seoul April 29, 2016

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Address for correspondence:
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National
Defense Medical Center, No.325, Sec. 2, Neihu Rd., Neihu Dist., Taipei City, 11464, Taiwan
Division of Cardiology
Department of Internal Medicine
Taoyuan Armed Forces General Hospital
Taoyuan County, Taiwan
You can find me at:
shangz0216@gmail.com
I am Guo-Shiang Tseng, MD
Hello!

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TCTAP 2016
C-123
Inadvertent Extraction of a
Drug Eluting Stent with a
Thrombus Aspiration Catheter
During Primary Percutaneous
Coronary Intervention

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An entrapped thrombus aspiration catheter (TAC)
with the deployed stent is uncommon, but one of
the nightmare complications
in the cardiac cath lab.
Henry Fuseli, 1781
The
Nightmare

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Case Briefing
Risk facrors:
1. Cigarette smoking
2. Diabetes
3. Hyperlipidemia
◈Mr. Zhang, 45-year-old male smoker
◈Ongoing angina pectoris for the last 4
hours
◈HR: 53/min, BP: 76/56 mmHg
◈ECG and UCG: acute inferior wall STEMI

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Cardiac Catheterization Findings
◈RCA: Total
occlusion of
the M/3
◈LM: Patent
◈LAD: Luminal
irregularity
◈LCx: 50% stenosis
of the M/3

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Interventional Management
JR 3.5 (7.0Fr) SION wire Thrombuster II
(Model No.: T2R6SA4W)

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Interventional Management
TIMI 2 flow Rewiring & 2nd Thromboaspiration Entrapped
Grade 1 thrombus !?

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Interventional Management
Rescue GW
(SION)
Balloon !? En-bloc retrieval

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Interventional Management
Type C
Dissection
TIMI 2 flow Stent & Final

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Entrapment
Why?

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Extracted stent
Rescue SION
Extra-Support

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Extracted stent
Thrombuster II-6Fr
(T2R6SA4W)
1.7mm
10mm

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Dismantling

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Mechanism of Entrapment
 Abnormal resistance
 Shortened wire lumen length of TAC
 Improved flexibility and trackability
 Vulnerable part to break
 Arterial tortuosity
 Under-deployed stent
 Inadequate route of the guidewire

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Animation
of the
procedural complication

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“

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 Maintain original guidewire position
 Knuckle-wire technique
 Pay respect to the resistance during
device delivery
 Lengthened wire lumen of TAC
Take-Home Message
Circ Cardiovasc Interv. 2015 Feb;8(2)
J Invasive Cardiol. 2011 Jul;23(7)

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Thanks!
Any questions?
You can find me at:
shangz0216@gmail.com
Acknowledgments:
I wish to acknowledge and thank Dr. Wei-Shiang Lin and Jun-Ting Liou for providing
information and advice during preparation of the oral presentation.

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Life is an Adventure

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“

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Dare to dream