Author + information
- Yu Ho Chan1
Patient initials or identifier number
Relevant clinical history and physical exam
A 68 years-old man, with history of Diabetes Mellitus came for chest pain. Percutaneous coronary intervention was arranged following successful thrombolytic therapy of anterior ST-elevation myocardial infarction.
Relevant test results prior to catheterization.
Relevant catheterization findings
Coronary angiogram showed that the proximal to mid left anterior descending artery (LAD) was diseased with a 90% stenosis. There was diffuse minor disease over the distal left circumflex artery. The proximal and distal parts of right coronary artery was 70% stenosed respectively (Video, Fig)
The LM engaged with 6 Fr IL-3.5 guiding catheter. Two work-horse wires were placed at dLAD and D1. Vessel assessed by OFDI. A 2.25/38 and 3.0/38 DES were implanted at mid LAD and proximal LAD with overlapping. High pressure balloon post-dilatation was performed using a 2.5/15 and a 3.5 x 15 non-compliant balloons. The angiographic result was satisfactory.
During retrieval of the OFDI catheter, however, OFDI catheter found to be trapped, and the distal part of stent damaged with significant deformation (Fig).
1. A 1.0 x 15 mm balloon was advanced through the same guide wire of OFDI. It advanced near the proximal wire exit port of OFDI, both the balloon catheter and OFDI catheter were pushed forward and rotated gently in order to relieve the trapping (Fig). Since the distortion of the stent was severe, it was unsuccessful.
2. Then, the distal end of guide wire inserted into the cut OFDI catheter. Both OFDI catheter and the support guide wire inserted into Guideliner; it was advanced to try to relive the tripping but failed (Fig).
3. Another 7Fr guiding inserted through femoral artery assess. Run through wire 0.014/180 advanced to dLAD.
A 1.5 x 15 mm balloon was advanced into the distorted part. Low-pressure inflation was performed (eg. 2 atm). The OFDI catheter was then pushed and rotated gently (Remarks: High pressure big size balloon inflation must be avoided). The catheter could finally be retrieved successfully.
After removing the OFDI catheter, balloon inflation was done using 2.5 x 20 mm semi-compliant balloon, followed by high pressure balloon (3.5/15) inflation. Another2.75 x 28 mm DES deployed to cover the disrupted part. Further optimization performed by high-pressure non-compliant balloon inflation. Excellent angiographic result finally achieved. The likely mechanism was trapping of the flexible outer OFDI catheter shaft by the distal part of stent, as we could seethe distal stent distortion. This case illustrates a rare complication of intracoronary imaging catheter. Should the catheter get struck, various methods could be considered.