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Published on: May 21, 2017
The RASE Technique for Extraction of a Protruding Aorto-Ostial Coronary Stent
Raghav Gattani1, Evandro Martins Filho2, Ilan Vavilin3
1Virginia Heart, Falls Church, Virginia, USA; Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA.
Background:
Significant protrusion of an aorto-ostial coronary stent into the aortic root may complicate transcatheter aortic valve replacement (TAVR) by increasing the risk of valve-stent interaction, TAVR balloon rupture, or stent deformation. Safe management strategies remain poorly defined.
Case Summary:
An 84-year-old man undergoing pre-TAVR evaluation was found to have ostial right coronary artery disease; this was treated with percutaneous coronary intervention, resulting in 7-mm stent protrusion into the aorta, precluding safe TAVR. After heart team evaluation, the patient underwent intentional stent fracture, reverse hairpin-assisted guidewire re-entry, and controlled snare-assisted extraction of the protruding stent (termed the RASE technique [reverse hairpin-assisted avulsion and stent extraction]). Successful staged TAVR was later performed.
Discussion:
This case describes a novel guidewire-controlled technique for safe extraction of a protruding aorto-ostial stent, enabling definitive transcatheter valve therapy.
Take-Home Messages:
Aorto-ostial stent protrusion may preclude safe TAVR and requires multimodality assessment and heart team planning. The RASE technique may facilitate safe and controlled extraction of the protruding stent segment.
