Amplatz Gooseneck Snare Research Articles

Accidental coronary artery kinking by leadless pacemaker fixation tine.

We present a case of a 59-year-old woman who presented with a coronary syndrome soon after an uneventful leadless pacemaker (MicraVR™, Medtronic) implantation. A routine postoperative electrocardiogram (ECG) revealed alteration of the baseline ECG (Panel A, left) with appearance of a complete right bundle branch block (RBBB) and ST-segment elevation in V3 (Panel A, middle). She reported intermittent moderate chest pain which worsened in left lateral position. An emergency transthoracic echocardiogram showed minimal pericardial effusion (<0.5 mm) with a normal systolic left ventricular function. A coronary computed tomography angiogram suggested that the septal anchor of the pacemaker partially occluded the distal segment of the left anterior descending (LAD) artery (Panel B). This was associated with enhancement defects on septo-apical and apical segments, consistent with ischaemia. The coronary angiography confirmed the partial LAD kinking in relation to the device anchor which was considered extravascular (Panel C). After patient consent, pacemaker retrieval was successfully performed using a 26Fr Gore DrySeal™ introducer sheath, a 12Fr Cook Performer™ guiding sheath holding an EV3 Amplatz gooseneck Snare of 15 mm. Once the pacemaker was trapped and before applying traction, a 0.14 Asahi FielderXT™ coronary wire was inserted through the lesion, to protect the vessel in case of injury. The coronary integrity was confirmed after device removal (Panel D). The RBBB disappeared 48 h later, leaving a Q wave in lead V3 (Panel A, right). Systematic postoperative ECG is warranted after leadless pacemaker implantation.

Thrombectomy of Inferior Vena Cava Fat Embolism after Trauma

A 19-year-old man involved in a head-on motor vehicle collision presented with multiple injuries, including a displaced right femur fracture. Two days after presentation, a computed tomography scan was obtained to evaluate new-onset hematuria, and it showed an extensive hypoattenuating filling defect in the inferior vena cava (IVC) (Fig 1), concerning for free-floating fat embolus. The interventional radiology department was consulted for embolectomy due to the risk of pulmonary embolism, contraindication for anticoagulation in the setting of trauma, and decreased likelihood of fat thrombus responding to anticoagulation. Cavogram showed an extensive right iliocaval filling defect (Fig 2a). A suprarenal IVC filter was placed prior to embolectomy to prevent central migration. Following mechanical embolectomy using an Amplatz Goose Neck Snare (Medtronic, Minneapolis, Minnesota) and suction via guiding catheters, a repeat cavogram demonstrated partially embolized fat thrombus trapped at the IVC filter apex (Fig 2b), which was removed with the snare. Histopathology of the fat emboli (Fig 2c) showed “thrombus with entrapped fat.”

PORT-A-CATH catheter rupture: case report

Introduction: The modern management of cancer treatment requires access to the venous system repeatedly for the passage of drugs, fluids and blood components. Peripheral veins are rapidly damaged by repeated punctures and by fluids that pass through them. To solve this problem, long-term vascular accesses avoid repeated punctures. One type of long-term venous access is the Port-A-Cath, which is an implantable device usually in the chest with a central venous catheter. Case report: Next, the case of a 34-year-old female with a diagnosis of breast cancer in the right breast is presented. It is treated with a radical mastectomy, and after the procedure a port-a-cath is placed in the left subclavian route for future treatments. The first cycle of chemotherapy is performed, later the patient reports pain at the catheter placement site with increased volume and progressive increase in pain. The patient goes to her health center for an evaluation, they decide to take a chest X-ray showing the migration of the catheter. The management used was through the seldinger technique at the femoral puncture site with a 6 Fr Amplatz GooseNeck Snare Guide, with which it was possible to extract the foreign body at the level of the left brachiocephalic vein. Conclusion: The implantation of a Port-A-Cath catheter is associated with some risks in the process. Catheter and patient care should be maintained to decrease the incidence of complications.

Unusual Suspect Causing Myocardial Infarction

An 84-year-old man with New York Heart Association functional class III/IV, due to prolapse of segment 2 of the anterior mitral valve leaflet with severe regurgitation as a result, was admitted for elective percutaneous edge-to-edge mitral valve repair. Significant coronary artery disease was ruled out previously. The left ventricular systolic function was normal with moderate concomitant aortic regurgitation. Mitral valve surgery was not considered a suitable option by the heart team due to frailty and a prohibitive surgical risk profile. The patient had an indication for transcatheter mitral-leaflet approximation, using the MitraClip-NT device (Abbott Vascular, Abbott Park, IL, USA). Implantation of the first clip resulted in insufficient reduction of mitral regurgitation. Therefore, a second device was positioned. Within minutes after release, transesophageal ultrasonography showed single leaflet device attachment of the second device, necessitating the deployment of a third device in order to stabilize the flailing clip (Figure 1a). Although regurgitation was reduced to moderate hereafter, flailing of the second device persisted. Two days later, the patient developed severe chest pain and cardiogenic shock. Electrocardiography showed ST-elevation in the inferior leads, corresponding to acute inferior wall myocardial infarction. Coronary angiography showed a dislodged clip seated in the right coronary ostium (Figure 1b). A 24Fr sheath was placed in the right femoral artery. After several attempts, a 35-mm Amplatz gooseneck snare was successfully positioned around the clip (Figure 1c). Subsequently, the device was retracted across the thoracic and abdominal aorta into the femoral sheath, which was successfully removed thereafter (Figure 1d). After the procedure, the patient was hemodynamically stable with normalization of the electrocardiogram. Transcatheter mitral-leaflet approximation using the MitraClip-NT device is used in high-risk patients with symptomatic mitral valve regurgitation. This unique case demonstrates an extremely rare complication of this procedure with a successful percutaneous solution. No potential conflict of interest was reported by the authors.

Preservation of the Inferior Mesenteric Artery With a Surgeon-customised Fenestration

Abdominal aortic aneurysms (AAA) are most frequently treated by endovascular aneurysm repair (EVAR). A recognised drawback of EVAR is loss of the inferior mesenteric artery (IMA), which when associated with the additional occlusion of both hypogastric arteries, puts the patient at risk of ischaemic colitis or pelvic ischaemia. A surgeon-customised fenestration technique used in a 70 year old man with an AAA, occluded hypogastric arteries, and a large IMA is described. The diameter of the IMA, distance to the lower renal artery, and clock face positions were assessed with TeraRecon software (TeraRecon Foster City, CA, USA). The main body of an Endurant stent graft (Medtronic, Dublin, Ireland) was partially unsheathed. The location and shape of the fenestration was drawn on the graft between two rows of stent. A 6 mm fenestration was created by using a 1205 °C cautery loop tip (Accu-Temp; Beaver-Visitec International, Waltham, MA, USA). To prevent the burning of the polyester, the graft was continuously irrigated with cold isotonic saline. A segment of a 25 mm Amplatz goose neck snare (Medtronic) was sutured around the fenestration with a polytetrafluoroethylene monofilament suture (CV-5 Gore-Tex; WL Gore & Associates, Flagstaff, AZ, USA) to serve as a radio-opaque marker (Fig. 1A). The graft was then re-sheathed by using a silicone rubber band tightly wrapped around the graft and loosened gradually when the sheath came over (Fig. 1B). Once the stent graft was deployed, the fenestration and the IMA were catheterised with a SIM1 catheter and a 7 × 22 mm covered stent (Advanta V12; Maquet, Sunderland, UK) (Fig. 2A and B) was subsequently deployed and flared with a 9 × 20 mm angioplasty balloon.Figure 2(A) Catheterisation of the inferior mesenteric artery by surgeon-customised fenestration. (B) Post-operative three dimensional reconstruction showing patency of the fenestration and occlusion of both hypogastric arteries.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Surgeon-customised fenestration is a straightforward technique that provides an option for maintaining IMA patency in patients at risk of ischaemic colitis and pelvic ischaemia following infrarenal EVAR.

Midterm Results of Endovascular Treatment for Iliac Vein Compression Syndrome from a Single Center

The efficacy of endovascular interventional treatment for iliac vein compression syndrome (IVCS) is not well studied. The purpose of our study was to investigate the clinical outcome of endovascular interventional treatment for IVCS. Data of 68 patients with IVCS, who underwent interventional treatment in our hospital, were analyzed retrospectively. Among these patients, 46 had lower extremity varicose veins. Sixty-five patients underwent stent implantation, and 3 patients underwent simple balloon angioplasty. Fourteen patients had post-thrombotic syndrome (PTS) and 11 patients had acute deep venous thrombosis (DVT). Among these 14 patients with PTS, 12 underwent stent implantation and 2 underwent iliac venous simple balloon angioplasty. On the other hand, 9 of the 11 patients with DVT underwent catheter-directed thrombolysis (CDT) and then stent implantation. Of the remaining 2 patients, one underwent Angiojet Rheolytic thrombectomy (ART) before CDT and the other underwent CDT with simple balloon angioplasty. The stenosis rate of iliac vein and the circumference differences between the affected limb and healthy one were measured before and after operation. These patients were followed up with duplex ultrasound postoperatively. A total of 75 stents were placed in 65 patients. The diameter and the length of stent were 6 to 14mm (mean 12.5±2.0mm) and 40 to 260mm (mean 82.5±36.9mm), respectively. CDT with/without ART was performed, using urokinase and/or alteplase, after inferior vena cava filtration in all of 11 patients with DVT, without the recurrence of pulmonary embolism. The difference in iliac venous stenosis was statistically significant ([91.2%±8.4%] [70.0% ∼ 100.0%] vs. 3.9%±13.0% [0 ∼ 70.0%], P < 0.01). The patency rates at 1-, 3-, 6- months, 1year, and 2years were 98.5%, 95.6%, 94.1%, 92.4%, and 90.7%, respectively. Four patients (5.9%) suffered from minor bleeding at puncture point and were successfully treated with compression. However, 1 (1.5%) patient underwent stent implantation of right iliac vein that became complicated due to migration of stent to the right ventricle which was successfully arrested by Amplatz Goose Neck Snare Kit. The incidence of PTS was 10.3% (7/68) during the follow-up at 1 to 24 (mean 18.2±7.7) months. Interventional therapy for patients of IVCS is safe and effective. Satisfactory outcomes were obtained for stent placement for IVCS.

Late MitraClip Embolization: A New Cause of ST-Segment-Elevation Myocardial Infarction.

Percutaneous edge-to-edge mitral valve repair using the MitraClip device (Abbott Vascular) is currently indicated for high-risk patients with symptomatic severe mitral valve regurgitation. The percutaneous approach, although inferior to surgical mitral valve repair, has an excellent safety profile. We report the first case of ST-segment–elevation myocardial infarction caused by late embolization of MitraClip to the right coronary ostium. An 80-year-old gentleman with severe symptomatic mitral regurgitation and multiple cardiac risk factors including coronary artery disease, moderate aortic stenosis, atrial fibrillation, hypertension, and moderately reduced left ventricular systolic function underwent percutaneous mitral valve repair with 3 MitraClips at another medical center. The first clip was deployed in A2-P2 position with a 12 to 6 o’clock orientation, despite having difficulties grasping the posterior leaflet because of significant degree of flail (Movie I in the Data Supplement). Given a moderate residual regurgitation (Movie II in the Data Supplement), a second clip was placed just lateral to the first one. After full release of the second clip, there appeared to be a single leaflet attachment of both clips with one free clip attached to the anterior leaflet and one free clip attached to the posterior leaflet (Movie III in the Data Supplement …

The successful retrieval of a broken guide wire from the diagonal branch of the left anterior descending coronary artery complicated by partial stent rolling.

Percutaneous coronary interventions (PCIs) are relatively safe, and the complication rate is low in comparison to cardiac surgery revascularization. The incidence of broken or retained PCI equipment is about 0.1–0.8% [1]. We report a successful retrieval of a fractured guide wire by using a percutaneous catheter Amplatz GooseNeck Snare and Microsnare Kit (Covidien, Plymouth, USA), which was complicated by stent deformation in the form of rolling up its distal part after retracting a piece of the guide wire. This artificial damage to the implanted stent was initially ineffectively treated with balloon angioplasty and finally successfully with double drug-eluting stent (DES) deployment.

Mechanical embolectomy for acute ischemic stroke in the anterior cerebral circulation: the Gothenburg experience during 2000-2011.

Intra-arterial treatment of proximal occlusions in the cerebral circulation have become an important tool in the management of acute ischemic stroke. Our goal was to evaluate the safety and efficacy of intra-arterial acute ischemic stroke treatment performed in our institution in consecutive patients with anterior circulation occlusion during 2000-2011. We identified, in our data base, 156 consecutive cases with anterior acute ischemic stroke treated intra-arterially during 2000-2011. Stroke severity was defined according to the National Institutes of Health Stroke Scale, the results of the procedure were defined according to the modified Thrombolysis in Cerebral Infarction score, and clinical outcome was defined according to the modified Rankin scale, with favorable outcome ≤2 at 90 days. The mean admission NIHSS score was 19.4 (median, 20), with a mean time from stroke onset to groin puncture of 197 minutes (median, 171 minutes). The embolectomy tool of choice was the Amplatz GooseNeck snare (83%). Successful recanalization (modified TICI 2b +3) was seen in 74% of cases. A mRS ≤ 2 at 90 days was seen in 42% with a mortality rate of 17% and symptomatic intracerebral hemorrhage in 4%. A high recanalization rate was obtained with the Amplatz GooseNeck snare without any device-related complications. Favorable outcome, mortality, and symptomatic intracerebral hemorrhage are comparable with results of newer embolectomy devices.

Rescue removal of disrupted balloon catheter from right coronary artery and aortic arch

We present the case of a 70-year-old female patient diagnosed with unstable angina, who was qualified to coronarography in a peripheral interventional cardiology department. Critical stenosis of right posterior descending artery was found. During percutaneous coronary intervention, after-stent balloon catheter interrupted and was left partially in the right coronary artery sticking out of the aortic arch. In a second attempt at removal, using an Amplatz GooseNeck snare, operators managed to take the broken balloon out of the intravascular space.

Transjugular removal of an intravascular catheter fragment using a snare loop catheter

Central venous catheters are widely used for various purposes, including central venous pressure measurement, total parenteral nutrition, blood sampling, transfusion of blood products, chemotherapy or long-term antibiotic therapy. Catheter fragmentation, a rare complication, results in an urgent interventional or surgical removal. The distal tip of a femoral catheter was accidentally severed in a 4-month-old girl with the diagnosis of tetralogy of Fallot after emergency shunt operation. Posteroanterior X-ray revealed a catheter fragment in the left iliac vein. The fragment was successfully removed transjugularly through a sheath inserted into the right internal jugular vein advanced through vena cava superior, the right atrium and vena kava inferior, using a 4F Amplatz Goose Neck Snare catheter. No complication was seen during the procedure. Transcatheter removal of the foreign body is a safe and effective method. It is possible to remove the foreign body through several arterial and venous routes. In selected patients, transjugular route can be preferred to capture the foreign body thanks to its ease of access of and appropriate angle.

Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

Purpose:Proximal migration of the ureteric double J stent is a rare but known complication. We describe three cases where a minimally invasive technique for retrieval of displaced double J stents using Amplatz™ goose-neck snare was successful.Materials and Methods:A retrospective review of patients with displaced double J stent was carried out, in whom cystoscopy guided retrieval of double J stent was attempted with the help of Amplatz goose-neck snare under radiological control.Results:All three patients were under the age of 3 years. Two patients had migrated double J stent following pyeloplasty and in one patient the double J stent was displaced during a retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent was successfully achieved using Amplatz goose-neck snare. There were no postoperative complications.Conclusion:Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children.

Renal Artery Stenting assisted by an Amplatz Gooseneck Snare Catheter for Severe Renal Artery Stenosis after Endovascular Abdominal Aortic Aneurysm Repair

Renal Artery Stenting assisted by an Amplatz Gooseneck Snare Catheter for Severe Renal Artery Stenosis after Endovascular Abdominal Aortic Aneurysm Repair

Percutaneous Transhepatic Release of an Impacted Lithotripter Basket and Its Fractured Traction Wire Using a Goose-Neck Snare: a Case Report

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.

Retrieval of dislodged coronary stent from left renal artery by gooseneck snare

Abstract A rapamycin-eluting stent was dislodged during attempt of implantation at the proximal right coronary artery, which was found by fluoroscopy to have migrated into the anterior trunk of the left renal artery. We chose a 5 mm diameter Amplatz gooseneck snare and successfully retrieved the lost stent from the lodging vessel.

Ultrasonography-guided percutaneous transhepatic portacaval shunt creation

We successfully created a percutaneous transhepatic portacaval shunt under ultrasonography (US) guidance in a 46-year-old man with refractory ascites. The shunt was created to salvage an attempt to create a transjugular intrahepatic portosystemic shunt (TIPS) that failed because of the elevated level of portal vein bifurcation due to alcoholic liver cirrhosis. Under US guidance, we simultaneously punctured the right branch of the portal vein and the inferior vena cava (IVC) using a two-step biliary drainage set. An Amplatz gooseneck snare was introduced transjugularly to retrieve the percutaneously inserted guidewire. The intrahepatic tract between the portal vein and the IVC was dilated using a balloon catheter, and a stent was placed in the tract. The patient showed complete resolution of ascites at discharge. We assume that our method is an alternative method for TIPS creation in patients with inadequate anatomical relations between the portal vein branches and the hepatic veins. This approach is thought to be feasible for patients with occluded or small hepatic veins.

Biodisk: A new device for closure of patent foramen ovale: A feasibility study in swine

To evaluate the feasibility, effectiveness, and safety of a porcine small intestinal submucosa (SIS)-covered Biodisk (BD) for the closure of patent foramen ovale (PFO) in swine. Twelve piglets (9-30 kg) with PFO ranging in size from 6 to 12 mm were used for the in vivo testing. The BD device consisted of two basic nitinol wire components covered with platinum coil, a flexible SIS-covered ring, and an anchor. The BD was advanced through an 8-Fr sheath from the femoral vein. Nine acute animals were used to test the BD for deployment, stability, immediate shunt closure, and device repositioning before or after its detachment. To assess retrievability, four devices were deployed and intentionally embolized into the RA (n = 2) and LA (n = 2). The effectiveness of the device was evaluated by angiocardiography. EKG was recorded before and after PFO closure for 3 hr. From the 12 animals, nine were acute and three were followed; one for 6 weeks, one for 12 weeks, and one for 16 weeks. Successful device implantation was achieved in all animals with no shunting of contrast media observed during follow-up in. One animal needed to have device repositioned for complete PFO occlusion because of suboptimal placement at the first attempt. The device was easily placed and retrieved before detachment in all nine animals in the acute study. None of the BDs spontaneously embolized during release or on follow-up. EKG did not demonstrate arrhythmias during or after treatment. Four intentionally embolized BDs were easily retrieved with an Amplatz goose neck snare. Macroscopic and histologic evaluation of the three long-term animals showed that devices were well incorporated in the atrial septum with complete shunt closure. The SIS showed progressive remodeling with the host cells. There was also progressive endothelization of the BD device. The BD device deployment is feasible, safe, and effective. Long-term studies are needed to evaluate its long-term effectiveness.

Snare Technique for the Placement of a Peripherally Inserted Central Catheter in the Neonatal and Pediatric Patient

The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access. An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PICC placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up. Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy. This technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.

Retrieval of an embolized amplatzer septal occluder

Percutaneous closure of secundum atrial septal defect (ASD) by various devices has been proven to be an effective and safe treatment modality for patients with congenital heart diseases. However, we have to be aware of the potential early and late complications like device embolization and formulate plan for rescue procedures. We have reported a case of successful closure of a large secundum ASD in a 23-year-old woman by a 40 mm Amplatzer septal occluder (ASO), which embolized into the right ventricle 4 hr after the procedure. This had caused palpitation and nonsustained ventricular tachycardia. Patient safety was our most important concern and after discussion with the cardiac surgeons and the patient, we would like to make a percutaneous stepwise attempt for retrieval. We first applied an endocardial biopsy forcep to grap the disk of the ASO to fix and stabilize the dislodged device. This would prevent the device from obstructing the inflow and outflow tract and causing catastrophic consequences. Then, a 15-mm Amplatz gooseneck snare was used to catch exactly at the connecting hub of the ASO disk, and the whole apparatus could then be cautiously and safely retrieved out from her body without complications. This had saved her from an unplanned emergency open heart operation that carried significant bleeding complication.

Migration of an Ingested Foreign Body into the Right External Iliac Vein

Migration of an Ingested Foreign Body into the Right External Iliac Vein