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Successful Retrieval of the Distal Anti-embolic Device after Carotid Stenting Using the Balloon Bridge Technique
Ricky G Kurniawan1,2, Abdulrahman Hamad Al-Abdulwahhab2,3, Yunsun Song2
1Neurovascular Division, National Brain Center Prof. Dr. Mahar Mardjono Hospital, University of Airlangga, Jakarta, Indonesia.
Insights
Retrieving the anti-embolic device (AED) during carotid artery stenting (CAS) can be challenging. A novel balloon bridge technique successfully facilitated AED retrieval after standard methods failed, ensuring patient safety.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
Background:
- Carotid artery stenting (CAS) procedures can encounter difficulties in retrieving the distal umbrella of anti-embolic devices (AEDs).
- Standard retrieval techniques for AEDs may sometimes prove unsuccessful.
Purpose of the Study:
- To describe a case of challenging AED retrieval during CAS.
- To present the successful application of the balloon bridge technique for AED retrieval.
Main Methods:
- A 62-year-old woman with severe carotid bulb stenosis underwent CAS.
- Standard AED retrieval failed due to a ledge effect between the AED guidewire and the stent mesh.
- The balloon bridge technique was employed, involving partial balloon inflation to minimize the ledge effect and facilitate catheter advancement.
Main Results:
- The balloon bridge technique allowed the guiding catheter to be advanced beyond the stented segment.
- The umbrella portion of the AED was successfully and easily retrieved without complications.
- This technique effectively addressed the ledge effect that hindered standard retrieval.
Conclusions:
- The balloon bridge technique offers a viable solution for AED retrieval during CAS when standard methods fail.
- This method enhances procedural safety and efficiency in challenging carotid stenting cases.
Background:
During carotid artery stenting (CAS), retrieval of the distal umbrella portion of the anti-embolic device (AED) could be difficult. Herein, we report a case of left CAS managed with balloon angioplasty and stent placement with successful retrieval of the umbrella portion of the AED using the balloon bridge technique after failure of retrieval with the standard technique.
Case Presentation:
After successful revascularization of the asymptomatic severe carotid bulb stenosis in a 62-year-old woman, we could not pass the re-sheathing catheter over the deployed stent because of the ledge effect between the guidewire of the AED and the stent mesh. However, using the balloon bridge technique, which helped minimize the ledge effect, we could advance the guiding catheter beyond the stented segment over the partially inflated balloon. The umbrella portion of the AED could be easily retrieved through the guiding catheter without complications.
Conclusion:
During CAS, the balloon bridge technique could be used to retrieve the AED after failure of retrieval with the standard techniques.
