Author + information
- Takuya Tsujimura1,
- Takayuki Ishihara1,
- Osamu Iida1,
- Shin Okamoto1,
- Kiyonori Nanto1,
- Shota Okuno1 and
- Masaaki Uematsu1
Patient initials or identifier number
Relevant clinical history and physical exam
A 70-year-old man with dyspnea on exertion was referred to our hospital. Hiscoronary risk factor were diabetes mellitus and dyslipidemia. A sirolimus-eluting stent (SES, Cypher 3.5 x 18 mm) was implanted for astenotic lesion in the middle part of left anterior descending artery (LAD) and2 SESs (Cypher 3.0 x 18 mm, Cypher 3.0 x 8 mm) were implanted in the distal part of LAD 8 years ago.
Relevant test results prior to catheterization
Electrocardiogram showed complete right bundle branch block. Echocardiogram shows good ejection fraction of 74% with normal valves and no chamber enlargement. Serum creatinine level was 1.04 mg/dl and eGFR was 71 ml/min.
Relevant catheterization findings
Coronary angiography showed a chronic total occlusion (CTO) of the middle part of left anterior descending artery (LAD) with collaterals from the septal branch to the distal part of LAD. There was no stenotic lesion in the right coronary artery(RCA) and Collaterals were not detected from RCA to LAD.
We could cross the lesion with antegrade approach and we implanted everolimus-eluting stent (EES, SYNERGY 2.25 x 16 mm) in the distal part of LAD with overlapping the distal edge of SES. The implantation pressure was only 7 atmosphere because the distal reference area was small. Then, intravascular ultrasound (IVUS, View IT) catheter was inserted to evaluate the stented segment. However, it did not pass the stented segment. Although, we tried to retrieve the IVUS catheter, it was impossible due to some resistance and the catheter was stuck at the distal edge of EES. Although we tried to cross the site with another guidewire, it could not pass. After the retrieval of imaging core of IVUS catheter, we inserted 0.021 inch guidewire into the lumen. However, it was still impossible to retrieve the IVUS catheter. Though, we advanced the child catheter (GuideLiner), it did not reach the stent distal edge. As we thought theunderexpansion and the incomplete stent apposition of the distal edge of EES were the cause of IVUS entrapment, we advance a 2.0 mm balloon catheter on the guidewire which IVUS catheter put on and dilated it at the EES distal edge with 14 atmosphere. Finally, we succeeded to retrieve the IVUS catheter.
We experienced a case complicated with IVUS catheter entrapment after coronary artery stenting. In our case, It was considered that the under expansion and the incomplete stent apposition of the distal edge of EES was the cause of IVUS entrapment. We advanced balloon catheter on the guide wire which IVUS catheter put on and dilated it at the EES distal edge. Finally, we succeeded to retrieve the IVUS catheter.