Author + information
- Shunsuke Ozaki1
Patient initials or identifier number
Relevant clinical history and physical exam
A 66-year-old man receiving regular dialysis for end-stage renal disease presented to our hospital with intermittent claudication. The ankle-Brachial Index (ABI) showed peripheral artery disease (ABI:0.96/0.72). Coronary angiography and aortography performed. It showed coronary triple vessel disease and left common femoral artery stenosis with severe calcification. PCI on LAD performed at first.
Relevant test results prior to catheterization
Electrocardiogram is normal.
ABI ratio is 0.96/0.72
Echocardiogram showed preserved LVEF. There was no a synergy of left ventricular function.
Labo Data) GOT5U/L, GPT 6U/L, γGTP 14U/L, BUN 56.4 mg/dl, Cre 12.2 mg/dl, WBC 6000/μl, Hb12.0 g/dl.
Relevant catheterization findings
RCA#1-2 90% stenosis with calcification, #3 50%, LAD#6 75%, #7 90% stenosis with calcification and bend, LCX #11 90% stenosis with calcification,
Left Common Femoral Artery (CFA) 90% stenosis with calcification.
Firstly, PCI on LAD was performed. 7Fr. Guiding catheter inserted from the right femoral artery. SION blue wire crossed on LAD. However, a novel micro catheter (Caravel MC; ASAHI-INTECC, Japan) did not pass. The Caravel was stuck after pushing. The tip of the Caravel ruptured and was left in the vessel when pulled hard. Though Ensnare (Merit Medical,USA) inserted to retrieve the tip of the Caravel, it did not work. Therefore, XT-Rwire crossed, and dilation with 1.5 mm to 2.0 mm diameter balloons were performed, still Ensn did not pass. Three wires wounded around and finally the tip was taken out. SION wire inserted again, the balloon did not pass, but we succeed when changing to XT-R wire. A drug eluting stent deployed at LAD. Final angiogram showed better flow of LAD.
The fall of devices are seen sometimes, and there are several ways of retrieve it. If snare is possible, it is the most secure way. Though passing through the vessel seems difficult, wounding a wire is effective. Generally, a support wire is efficient to deliver a device, but as we saw in this case (the case with severe calcification and bend), sometimes a soft wire is more efficient than a support wire.