Surgical Extraction of Fragmented Stent and Guidewire After Angioplasty Smriti Saraf, MRCP, Adam DeBelder, and Jonathan Hyde, FRCS Department of Cardiology and Cardiothoracic Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
Fig 1.
A
61-year-old man with stable angina was admitted for elective angioplasty to the posterior descending artery (PDA) branch of the right coronary artery (RCA). There was moderate disease in the middle segment of the RCA. Angioplasty was attempted by way of the right radial artery. A hydrophilic wire Choice PT extra support (Boston Scientific, Miami, FL) was advanced into the PDA across the lesion, and another hydrophilic wire Balance
Middleweight (BMW) Universal (Abbott Vascular, IL) was advanced into the posterior left ventricular branch of the RCA. The lesion was ballooned over the Choice PT extra support wire with an attempt to deploy a Nobori (Terumo Europe) 2.5 24 mm stent across the PDA lesion. The stent became stuck in the middle segment of the RCA, and attempts at withdrawal proved futile, resulting in deployment of the stent in the mid-RCA with the BMW wire jailed in the vessel. An attempt at withdrawal of the BMW wire was unsuccessful, resulting in fragmentation and coiling of the Choice PT extra support wire proximal to the stent (Fig 1). Multiple attempts were made to balloon at the level of the coiled wire without success. An operation in the form of extensive endarterectomy with patching of the ruined vessel after stent extraction (Fig 2) was required, followed by saphenous venous grafting to the distal RCA.
Address correspondence to Dr Saraf, Royal Sussex County Hospital, Eastern Rd, Brighton, United Kingdom BN2 5BE; e-mail: smriti.saraf@ gmail.com.
Ó 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
Ann Thorac Surg 2013;96:2251 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.03.110
FEATURE ARTICLES
Fig 2.
Fig 1.
A
61-year-old man with stable angina was admitted for elective angioplasty to the posterior descending artery (PDA) branch of the right coronary artery (RCA). There was moderate disease in the middle segment of the RCA. Angioplasty was attempted by way of the right radial artery. A hydrophilic wire Choice PT extra support (Boston Scientific, Miami, FL) was advanced into the PDA across the lesion, and another hydrophilic wire Balance
Middleweight (BMW) Universal (Abbott Vascular, IL) was advanced into the posterior left ventricular branch of the RCA. The lesion was ballooned over the Choice PT extra support wire with an attempt to deploy a Nobori (Terumo Europe) 2.5 24 mm stent across the PDA lesion. The stent became stuck in the middle segment of the RCA, and attempts at withdrawal proved futile, resulting in deployment of the stent in the mid-RCA with the BMW wire jailed in the vessel. An attempt at withdrawal of the BMW wire was unsuccessful, resulting in fragmentation and coiling of the Choice PT extra support wire proximal to the stent (Fig 1). Multiple attempts were made to balloon at the level of the coiled wire without success. An operation in the form of extensive endarterectomy with patching of the ruined vessel after stent extraction (Fig 2) was required, followed by saphenous venous grafting to the distal RCA.
Address correspondence to Dr Saraf, Royal Sussex County Hospital, Eastern Rd, Brighton, United Kingdom BN2 5BE; e-mail: smriti.saraf@ gmail.com.
Ó 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
Ann Thorac Surg 2013;96:2251 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.03.110
FEATURE ARTICLES
Fig 2.
