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Patient initials or identifier number
Relevant clinical history and physical exam
A 56 years old male with hypertension and hyperlipidemia suffered from AMI, so he was performed emergency CAG at our hospital one year ago. CAG showed a total occlusion in LCX and an intermediate stenosis in LAD. We performed PCI for LCX. After EES 3.0/28 mm impanted at target lesion, IVUS showed hematoma at stent proximal edge. Therefore, EES implanted to cover hematoma. The stent protruded a little to LMT. This time he was hospitalized for the PCI to progressive lesion of LAD.
Relevant test results prior to catheterization
Relevant catheterization findings
This time, CAG showed no restenosis in the stent of LCX. The lesion in LAD progressed, then we measured FFR. FFR was 0.42.
With an 6-Fr system via the right radial artery, primary PCI performed to the LAD. The floppy wire could be passed the lesion easily. Next, we performed IVUS. Although IVUS catheter could not be passed the lesion.At this time, the IVUS trapped and it was difficult to remove it, and when it slowly pulled out, it tears. The snare could not be recovered, after which patient's chest pain worsened. Therefore, with an７-Fr system via the right femoral artery, PCI performed to the LAD. After confirming that the wire did not pass through the LCX stent strut with the IVUS, the stent placed in the midLAD. As the patient's condition stabilized, collection of the IVUS resumed. Again, stump of IVUS searched with another IVUS from the right radial artery, where the stump presented in the right subclavian artery .En-snare inserted from the right radial artery and confirmed that the snare grasped the stump of IVUS in the aortic system. When I pulled the snare, the LCX stent was pulled out at the same time. Finally, IVUS and angiogram showed the lesion dilated successfully.
I experienced the case that the IVUS catheter stuck and is difficult to remove. When the IVUS is caught, it is important to be conscious of the stent struts, to confirm with the IVUS how the previous stent was placed.