Transfemoral Coronary Intervention Research Articles

Trapping Technique for Successful Retrieval of a Ruptured Balloon Catheter Entrapped in Coronary Artery : A Case Report

Introduction: Device entrapment during PCI is an uncommon complication with incidence of less than 1%. Percutaneous retrieval should be favored as the treatment of choice for this condition. Case Illustration: A 61-year-old patient came for an elective percutaneous coronary intervention (PCI) procedure. She suffered from chest pain while doing moderate activities for 1 month. Angiography showed a diffuse lesion with maximum stenosis 90% in the proximal LAD, stenosis 75% in the proximal of Left Circumflex Artery (LCx), and diffuse lesions in the proximal and mid of the Right Coronary Artery (RCA). We decided to perform PCI in the LAD. A transfemoral coronary intervention was performed using a Judkins Left 3.5 (7F) guiding catheter to engage the LAD. A Guidewire ( Run-through NS Floppy) was advanced to the distal LAD. Balloon angioplasty was performed with a 2.75 x 15 mm Fluydo balloon in the proximal LAD at 16 bars, but the balloon was entrapped and while withdrawing the balloon, it accidentally ruptured in the LAD artery with the remaining segment inside the guiding catheter. A second Run-through NS Floppy Guidewire was inserted across the ruptured balloon and a 2.5 x 20 mm Fluydo Balloon was passed on the second wire and was inflated at 16 atm pressure, inside the guiding catheter, trapping the ruptured balloon. The ruptured balloon was successfully removed, by withdrawing the whole system, including the guiding catheter and the wire. Finally, we re-engaged the LAD with the same guiding catheter, passed the wire, and post dilated the stent on the LAD to achieve a good result. Conclusion: Percutaneous retrieval using trapping technique could represent a safe and effective technique for ruptured and entrapment of a balloon-catheter in a coronary artery.

Outcomes Following Percutaneous Coronary Intervention Before, During, and After Transition to a Default Transradial Approach at a Veterans Affairs Medical Center.

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.

Transradial vs. transfemoral coronary interventions in elderly diabetic patients – A single center experience in Bangladesh

Transradial vs. transfemoral coronary interventions in elderly diabetic patients – A single center experience in Bangladesh

Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

BackgroundThe transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients >80years with acute myocardial infarction (MI) undergoing PCI. MethodsA total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n=336, 17.3%) was compared with the TF group (n=1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate. ResultsIn the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139–0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334–1.240). ConclusionsIn octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success.

Design and rationale for the Minimizing Adverse haemorrhagic events by TRansradial access site and systemic Implementation of angioX program

Transradial intervention (TRI) and bivalirudin infusion compared with transfemoral coronary intervention or unfractionated heparin plus glycoprotein IIb/IIIa inhibitors decrease bleeding complications in patients with acute coronary syndromes (ACS). Although bleeding is thought to be associated with worse outcomes, it remains unclear whether TRI and bivalirudin both independently lower ischemic or combined ischemic and bleeding complications in ACS patients undergoing contemporary invasive management. The primary objectives of the MATRIX program are to assess whether TRI or bivalirudin as compared, respectively, with transfemoral coronary intervention (MATRIX access site) or unfractionated heparin plus provisional glycoprotein IIb/IIIa inhibitors, (MATRIX antithrombin) decrease the 30-day incidence of an ischemic (ie, death, myocardial infarction or stroke) or an ischemic and bleeding composite end point across the whole spectrum of ACS patients, including clarifying the optimal duration of bivalirudin infusion after percutaneous coronary intervention (MATRIX treatment duration). The MATRIX (NCT01433627) study, which incorporates 3 randomized comparisons in a nonfactorial manner and primary end points at 30 days and clinical follow-up ≤ 1 year, is a large-scale, multicenter study with blind event adjudication conducted at approximately 100 European sites. With 8,200 patients in the randomized comparison of access sites and 6,800 individuals participating in the randomized comparison of antithrombin regimens, this study will have ≥ 85% power for the primary end points. The MATRIX program aims at conclusively ascertaining the role of TRI and bivalirudin infusion in the whole spectrum of ACS patients undergoing contemporary invasive management.

Meta-analysis of randomized trials on access site selection for percutaneous coronary intervention in ST-segment elevation myocardial infarction.

IntroductionSuperior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI.Material and methodsElectronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model.ResultsTwelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38–0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43–0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52–0.86), p = 0.002 respectively).ConclusionsRobust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.

Clinical outcomes of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

Purpose: Transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI). However, it is more technically challenging and associated with failure in elderly patients because the elderly may be associated with advanced vascular disease with tortuosity of subclavian artery, aortic root dilation and calcification, and diffuse atherosclerosis. We compared the clinical outcomes of the TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods: A total of 1,945 (8.9%) octogenarians were selected from 21,815 patients in the Korea Working Group on Myocardial Infarction Registry. TR group was consisted of 336 (17.3%) patients and TF group 1,609 (82.7%) patients. Procedural success and complications, door-to-balloon-time, in-hospital mortality and major adverse cardiovascular event (MACE, defined as death, MI, or revascularization), and the death and total MACE at one-year were evaluated. Results: TR group had lower Killip class, but used more drug-eluting stents and longer stents compared to TF group. Extent of coronary disease and lesion severity were similar in both groups. Procedural success was not different (97.7% vs 98.3%), but in-hospital complications were significantly lower in TR group (8.1% vs 20.3%, p<0.0001). Door-to-balloon time was not different in both groups (84.5 vs 87.0 minutes, p=0.372) in 1,170 (60.2%) patients with ST-segment elevation MI. In-hospital mortality and MACE were significantly lower in TR group compared to TF group (3.4 vs 11.4%, p<0.0001; 3.4 vs 11.4%, P<0.0001, respectively). One-year mortality and MACE were also lower in TR group (9.8 vs 18.4%, p<0.0001; 13 vs. 21.9%, p=0.001, respectively). Conclusions: This study showed that, in octogenarians with acute MI who underwent PCI, TR approach was more effective for PCI than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.

TRANSRADIAL PCI IS ASSOCIATED WITH LOWER COST IN MEDICARE FEE–FOR–SERVICE BENEFICIARIES FOLLOWING ELECTIVE PCI

Prior studies demonstrate transradial (TRI) compared to transfemoral coronary intervention (TFI) reduces bleeding complications. However, limited cost–effectiveness data are available, specifically neither in large datasets nor in heterogeneous elderly populations at high bleeding risk. Our

Abstract 18262: Comparison of Transradial Versus Transfemoral Coronary Intervention in Octogenarians with Acute Myocardial Infarction: Results from the Korea Working Group on Myocardial Infarction

Background: The transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI), but is more technically challenging and associated with failure in elderly patients because the elderly may be associated with advanced vascular disease with tortuosity of subclavian artery, aortic root dilation and calcification, and diffuse atherosclerosis. We compared the results of TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods and Results: A total of 1,945 (8.9%) octogenarians were enrolled from 21,815 patients in the Korea Working Group on Myocardial Infarction Registry. TR group was consisted of 336 (17.3%) patients and TF group 1,609 (82.7%) patients. Procedural success and complications, door-to-balloon-time, in-hospital mortality and major adverse cardiovascular event (MACE, defined as death, MI, and revascularization) as well as those of one-year were evaluated. TR group had lower Killip class, but used more drug-eluting stents and longer stents compared to TF group. Extent of coronary disease and lesion severity were similar in both groups. Procedural success was not different (97.7% vs 98.3%), but in-hospital complications were significantly lower in TR group (8.1% versus 20.3%, p&lt;0.0001). Door-to-balloon time was not different in both groups (84.5 vs 87.0 minutes, p=0.372) in 1,170 (60.2%) patients with ST-segment elevation MI. In-hospital mortality and MACE were significantly lower in TR group compared to TF group (3.4% vs 11.4%, p&lt;0.0001; 3.4% vs. 11.4%, P&lt;0.0001, respectively). One-year mortality and MACE were also lower in TR group (9.8% vs. 18.4%, p&lt;0.0001; 13% vs. 21.9%, p=0.001, respectively). Conclusion: This study shows that, in octogenarians with acute MI who underwent PCI, TR approach for PCI was more effective than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.

Transradial and transfemoral coronary angiography and interventions: 1-Year outcomes after initiating the transradial approach in a cardiology training program

Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs. From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods. A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35%) of the CAs and in 72 (28%) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 ± 6.0 vs 11.0 ± 8.9, P = .63) or procedure (31.8 ± 11.5 vs 33.2 ± 13.8, P = .55) time throughout the academic year with a significant trend toward lower contrast use (128 ± 52 vs 110 vs 50, P = .04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 ± 8.9 vs 6.7 ± 6.8, P = .001) and procedure (33.2 ± 13.8 vs 27.2 ± 11.6, P = .0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups. A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.

Safety of transradial approach for percutaneous coronary intervention in relation to body mass index: a report from a Japanese multicenter registry

Transradial coronary intervention (TRI) is commonly performed in Japan, but its efficacy may differ from that in Western countries, particularly given the smaller body habitus of Japanese patients. We compared the clinical outcomes of TRI with those of transfemoral coronary intervention (TFI) and evaluated their relationship with body mass index in a multicenter registry. We analyzed data from 1230 patients who underwent percutaneous coronary intervention (TRI 306, TFI 924) at 14 Japanese hospitals from September 2008 to August 2010. Multivariate logistic regression analysis was performed to evaluate the odds ratio regarding complications between TRI and TFI. Propensity scores were used to adjust for differences in TRI and TFI, extracting 274 matched patients from each group for comparisons. The overall complication rate was significantly lower (10.8 vs. 18.0%, p = 0.003) and the bleeding complication rate trended lower (4.6 vs. 7.6%, p = 0.088) in TRI than in TFI. TRI was moderately associated with a smaller bleeding risk after multivariable adjustment (OR 0.54; p = 0.072). After propensity score matching, TRI was associated with significantly lower complication rates compared with TFI (9.5 vs. 18.2%, p = 0.003), especially bleeding complications (3.3 vs. 9.9%, p = 0.002) and puncture site bleeding (1.1 vs. 5.5%, p = 0.004). Notably, bleeding rate was inversely related to body mass index in both groups. TRI appeared to be a safe alternative to TFI in this Japanese real-world multicenter registry, which includes high numbers of TRI.

Safety and efficacy of transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction

The transradial approach has gained increasing popularity for elective percutaneous coronary intervention. However, the safety and feasibility of transradial coronary intervention (TRI) in acute myocardial infarction (AMI) remains uncertain. Hence, a meta-analysis of randomized trials was performed to compare outcomes of TRI with transfemoral coronary intervention (TFI) in patients with AMI. A systematic review of the literature revealed seven randomized trials involving 1306 patients. Endpoints extracted were access site complications, major adverse cardiovascular events, major bleeding, and procedural success. Combined relative risks (RRs) across all studies and 95% confidence intervals (CIs) were computed. A two-sided α error of less than 0.05 was considered to be statistically significant. Baseline characteristics were similar in both groups. Compared with patients undergoing TFI, risk of major adverse cardiovascular events (RR: 0.83, CI: 0.51-1.35; P=0.45) and major bleeding (RR: 0.51, CI: 0.20-1.26; P=0.14) was similar in patients undergoing TRI. The procedural success was similar with both approaches (RR: 0.99, CI: 0.96-1.02; P=0.59). However, incidence of access site complications was significantly lower in the TRI group (RR: 0.31, CI: 0.17-0.58; P<0.001). The meta-analysis suggests that TRI may be superior to TFI in reducing access site complications in patients with AMI. However, there is no difference in procedural success and major bleeding between the two groups.

Two different surgical pathways for urgent percutaneous coronary intervention

Objective To compare the advantages and disadvantages in urgent percutaneous coronary intervention ( PCI ) with transradial or transfemoral approach,and to explore the feasibility of urgent PCI with transradial approach in primary hospitals.Methods 90 patients with acute myocardial infarction who needed interventional therapy were divided into transradial approach group ( n =45 ) and transfemoral approach group ( n =45 ).Time to balloon opening after medical visit,success rate of the procedures,incidence rate of complications,duration of X-ray exposure,and length of hospital day were compared between the two groups.Results The success rate of the procedures,time to balloon opening after medical visit,and duration of X-ray exposure did not differ significantly between the two group ( P ＞ 0.05 for all comparisons ).Length of hospital day were shortened and rate of complications were lowered in the transradial procedure group ( P ＜ 0.01 and P ＜ 0.05 ).Conclusions Urgent percutaneous coronary intervention with transradial approach has a higher success rate and fewer complications,can relieve the pain level in patients,and is suitable to apply in primary hospital.But the prerequisite is accumulation of large amount of experience on transfemoral coronary intervention and transradial coronary angiography. Key words: Acute myocardial infarction; Coronary intervention therapy; Radial artery; Femoral artery; Primary hospitals

Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes

The aim of the present study was to examine the impact of the transradial approach (TRA), in comparison to the transfemoral approach (TFA), on PCI-related bleeding and patient outcomes in acute coronary syndrome patients who underwent PCI in the OASIS-5 trial. The primary outcome (death, myocardial infarction, refractory ischaemia) at nine days was similar in both groups (7.1% in 872 TRA and 7.7% in 7,013 TFA). Major bleeding was significantly lower in patients who underwent PCI with TRA by comparison to TFA (1.6% vs 3.5%, p<0.003, respectively). No difference between patients treated by fondaparinux or enoxaparin was noted for ischaemic events at nine days according to the access site. The rate of major bleeding at nine days was markedly reduced with fondaparinux when compared to enoxaparin for both access sites (from 4.8% to 2.3%, HR 0.48 [0.37-0.62], p< 0.0001 for TFA and from 2.4 to 0.9%, HR 0.36 [0.11- 1.16], p<0.08 for TRA). TRA is associated with substantial decrease of PCI-related bleeding in current contemporary pharmacological environment in comparison to TFA. Even in the context of low access site complication rate provided by TRA, fondaparinux was effective in reducing major bleeding.

Comparative analysis between the transradial and transfemoral approach coronary intervention

Objective To evaluate the safety and success rates of transradial coronary intervention and to compare the advantages and disadvantages of coronary interventional procedures between the transradial and transfemoral approach in order to provide physician and patients a reasonable choice. Methods A total of 160 patients undergoing coronary interventional procedures were randomly divided into observer group (transradial group with 80 cases) and the control group ( transfemoral group with 80 cases). The success rate of catheterization, local pain during and after operation, complications, comfort after operation and hospitalization duration were compared between two groups. Results The success rate of catheterization was not different statistically between two approaches (P> 0.05 ). In transradial group, the complications, pains after operation and hospitalization time were better than in transfemoral group. Conclusions The transradial approach coronary intervention is safe, effective, with less pain after operation, with less influence on patients' comfort and no requirement of rest on the bed. Key words: Radial artery; Femoral artery; Percutaneous coronary intervention

Operator vs. patient radiation exposure in transradial and transfemoral coronary interventions

We were interested by the recent report from Brasselet et al. 1 measuring radiation exposure to patients and operators after transradial and transfemoral coronary diagnostic and interventions. In brief, they showed that using standard leaded glass and flaps, transradial procedures were associated with higher patient and operator radiation exposures. In the light of these findings, they concluded that ‘radial route indication should be promptly reconsidered…’. Before such conclusion can be drawn, we would like to make the following comments: 1. Transradial approach has been initially described more than 15 years ago and it has become popular mainly outside US.2 Today, it is the best method to minimize the risks of access site complications and bleeding after percutaneous coronary interventions (PCIs).3 2. Bleeding post-PCI is a dreadful consequence, …

Comparison of 6 and 7 French guiding catheters for percutaneous coronary intervention: Results of a randomised trial with a vascular ultrasound endpoint

To perform a randomized, ultrasound controlled trial to define the procedural and clinical advantages and limitations of 6 French (Fr) compared with 7 Fr transfemoral coronary intervention in the stenting era. The use of 7 Fr guiding catheters may facilitate Percutaneous Coronary Intervention (PCI), but may be associated with increased vascular complications when compared with 6 Fr catheters. Patients undergoing PCI considered suitable for either a 6 or 7 Fr sheath and guiding catheter system were included. All vascular sheaths were removed with assisted manual compression. Femoral vascular ultrasounds were performed prior to hospital discharge and interpreted by a vascular surgeon blinded to treatment assignment. The primary endpoint was a composite of significant vascular complications including major haematoma, retroperitoneal haematoma, pseudoaneurysm, arterio-venous fistula, or femoral venous or arterial thrombosis. During the study, 414 patients (mean age 61+/-11 years, 27% females) were randomly assigned to 6 Fr or 7 Fr sheath groups. The incidence of major vascular complications was 5.7% in the 6 Fr group and 3.9% in the 7 Fr group (P=0.383). There was no significant difference in procedural or angiographic success between the groups. The use of contrast volume was higher in the 7 Fr group (157+/-58 ml vs. 144+/-58 ml; P=0.029). There was a trend toward better operator satisfaction with the 7 Fr guide (P=0.08). This prospective, randomized trial indicates no reduction in major peripheral vascular complications with the use of smaller guiding catheters in PCI. There was less contrast used in the 6 Fr group, which may benefit some patient subsets, however operators tended to prefer the larger 7 Fr system. The target coronary anatomy and need for complex device intervention should mandate the choice of guiding catheter size, not a perceived impact on vascular complications.

Comparison of treatment outcomes in patients ≥80 years undergoing transradial versus transfemoral coronary intervention

We assessed the effect of transradial access (vs transfemoral access) for percutaneous coronary intervention on postprocedure length of stay and patient outcomes (in-hospital complications and all-cause and cardiac death at 6 and 12 months) in 225 elderly patients (≥80 years old). Raw differences between transradial and transfemoral accesses were compared, and 3 forms of propensity score analysis were used to determine the true effect of transradial access. After matching to adjust for baseline differences in patient characteristics, remaining differences in outcomes and postprocedure length of stay were small and not statistically significant at the 95% level, but a decrease in postprocedural length of stay of nearly 1 day was observed and likely was not due to chance. Transradial access in patients ≥80 years old undergoing percutaneous coronary intervention should be preferred due to equivalent success rate and safety and likely reduction in postprocedural hospitalization.

Arterial infection and Staphylococcus aureus bacteremia after transfemoral cannulation for percutaneous carotid angioplasty and stenting

In this report, we present a patient who developed an infected femoral artery after repuncture cannulation for carotid angioplasty and intraluminal stenting. The case was complicated by persistent bacteremia and a delay in diagnosis before it was managed successfully with an autogenous replacement graft and appropriate antibiotics. Overt stent infection is exceedingly rare, but according to the literature describing transfemoral coronary artery intervention, the spectrum of clinical syndromes related to infection of the arterial puncture site includes local invasion, pseudoaneurysm formation, septic embolization to the distal limb, and bacteremia. The diagnosis requires a high degree of clinical suspicion and is often delayed. Although the incidence of infectious complications reported for percutaneous intra-arterial interventions historically has been low, the absolute number of these complications almost certainly will increase in the future because of the expanding array of interventional procedures that is becoming available.

Removal of Dislodged Stent by Using 8 Fr Sheath and Forcep during Transradial Coronary Stenting

Stent dislogement or migration is not a rare complication. Its incidence varies from 1.4% to 8% of the cases. When stent migration occurs, the usual treatment or management is to implant stent in the distal peripheral artery or proximal coronary artery. But, probably the best treatment is safe retrieval of the dislodged stent. During the transfemoral coronary intervention, undeployed stent can be more easily retrieved into the guiding catheter with relatively larger guiding catheter luminal space. Also, larger sheath can be changed more easily when the retrieval of stent is difficult. In the transradial coronary stenting, usual size of guiding catheter is 6 Fr, makes it difficult to retrieve relatively bulky stent when deployment of stent fails. We report 2 cases of stent dislodgment during transradial coronary stenting which can be successfully removed by using myocardial biopsy forcep through 8 Fr sheath. These combination could be one of the valuable methods, especially during transradial stenting. (Korean Circulation J 2000;30(10):1312-1315)