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Rescue retrieval of a trapped embolic protection device using a JB2-type balloon catheter
Yasuyuki Tatsuta1, Tatsuya Ogino1, Hideki Endo1
1Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
Insights
Retrieving a trapped embolic protection device during carotid artery stenting can be challenging. A novel technique using a balloon catheter successfully retrieved the device when standard methods failed.
Area of Science:
- Interventional cardiology
- Medical device technology
Background:
- Carotid artery stenting (CAS) is a key intervention for carotid artery stenosis.
- Embolic protection devices (EPDs) mitigate distal embolization during CAS.
- EPD retrieval can be complicated by stent geometry, leading to device entrapment.
Observation:
- During EPD retrieval, the device wire became caught on the stent's distal flare.
- Standard recapture catheters could not navigate the jammed EPD.
- The EPD wire was lodged between the stent flare and the vessel wall.
Findings:
- An extension wire was attached to the entrapped EPD.
- A 5.2-Fr JB2-type balloon catheter was advanced over the extension wire.
- The balloon catheter successfully traversed the stent and facilitated EPD retrieval.
Implications:
- This technique offers a feasible and effective solution for challenging EPD retrievals.
- It expands the armamentarium for interventionalists managing CAS complications.
- Successful retrieval minimizes procedural risks and improves patient outcomes.
Abstract:
Carotid artery stenting is a treatment option for patients with significant symptomatic or asymptomatic carotid artery stenosis. Although use of an embolic protection device during carotid artery stenting can prevent distal embolization, device retrieval after stenting can be difficult. In this report, during an embolic protection device retrieval, it was not possible to advance recapture catheters through the distal flare segment of the stent because the device wire would catch on the flare or become jammed between the flare and vessel wall. Then, an extension wire was connected to the end of the device and a 5.2-Fr JB2-type balloon catheter was advanced over the wire, which was able to pass through the stent. The use of a 5.2-Fr JB2-type balloon catheter to retrieve a trapped embolic protection device is feasible and effective if standard maneuvers fail.
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