| Endovascular rescue of a fused monorail balloon and cerebral protection device. | |
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MedLine Citation:
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PMID: 17696638 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To present a case of successful endovascular retrieval of a monorail predilation balloon fused to an embolic protection device (EPD) in the distal internal carotid artery (ICA) of a high-risk symptomatic patient. CASE REPORT: A 60-year-old man with documented systemic atherosclerotic disease had a severe (>70%) restenosis in the left ICA 3 years after endarterectomy. He was scheduled for carotid artery stenting (CAS) with cerebral protection; however, he developed unstable angina and was transferred to our facility, where the admitting team decided that staged CAS followed by coronary bypass grafting would be the best option. During the CAS procedure, a 6-mm AccuNet filter was passed across the lesion via a 6-F carotid sheath and deployed in the distal ICA without incident. However, the 4-x20-mm predilation monorail balloon was then advanced without visualizing the markers, resulting in inadvertent aggressive interaction that trapped the balloon's tip in the filter. Several maneuvers to separate the devices were unsuccessful. Finally, the filter/balloon combination was moved gently retrograde until the balloon was straddling the subtotal ICA lesion. The lesion was dilated to 4 mm with the balloon, and the sheath was gently advanced across the lesion as the balloon was deflated. Angiography excluded interval occlusion of the filter from the embolic debris during the aforementioned aggressive maneuvers and documented antegrade flow. The filter was slowly withdrawn into the 6-F sheath with simultaneous aspiration. A second 6-mm filter was deployed, and the procedure was completed satisfactorily. The patient did well, with no neurological sequelae. CONCLUSION: EPDs are an essential in carotid artery stenting and, keeping in mind the potential risks associated with their use, will help the operator avoid complications such as this one. |
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Authors:
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John E Campbell; Mark C Bates; Michael Elmore |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists Volume: 14 ISSN: 1526-6028 ISO Abbreviation: J. Endovasc. Ther. Publication Date: 2007 Aug |
Date Detail:
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Created Date: 2007-08-16 Completed Date: 2007-10-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100896915 Medline TA: J Endovasc Ther Country: United States |
Other Details:
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Languages: eng Pagination: 600-4 Citation Subset: IM |
Affiliation:
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Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Department of Surgery, Charleston Division 25304, USA. campbell1229@verizon.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon
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adverse effects,
instrumentation* Carotid Artery, Internal* / radiography Coronary Artery Bypass Coronary Stenosis / radiography, surgery, therapy* Device Removal* Embolism / etiology, prevention & control* Equipment Failure* Humans Male Middle Aged Severity of Illness Index Stents* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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