Page 40 - Journal of Structural Heart Disease Volume 5, Issue 5

233 Case Report
AB
Figure 6. Panel A. First rupture of stent catheter shaft at monorail point. Panel B. Second rupture of catheter shaft because of snaring.
trapped firmly between the surgical valve posts and the EDWARDS frame. This prohibited the ability to retrieve the catheter. The stent was retrieved while using a mechanical and forceful pull where the cor- onary stent struts were in contact with the surgical valve/THV frames. No further adjustment forward or backwards was feasible. Therefore, the chimney path that with the intent to be created was unable to be retrieved by the stent catheter. The only available op- tion to proceed was to deploy the left coronary stent in an undesirable position. The stent was partially in the left main artery and extended out, contacting in a vertical trajectory to the surgical/THV frames (Figure 5).
The plan was to be able to drag the stent balloon from its entrapped course between the surgical posts and the SAPIEN 3 frame and remove from the body. The left main coronary artery was rewired through the struts of the existing stent. Balloon dilatation of the left main stent strut was then performed. A sec- ond stent was deployed, creating a parallel stent- ed path that was initially felt to be necessary. Since the deflated balloon was unable to be retrieved, the winged balloon failed to pass in-between the surgical post and the SAPIEN 3 THV frame. A manual pulling force was applied to facilitate the retrieval of the stent balloon passing in-between the surgical bioprosthe- sis post and the EDWARDS SAPIEN 3 frame passage. Unfortunately, the balloon catheter shaft ruptured at the monorail port because of the pulling (Figure 6A). The left main stent was deployed in a poor position with an irretrievable deflated winged balloon inside
it, as previously described. The balloon was partially entrapped between the surgical bioprosthesis post and the EDWARDS SAPIEN 3 frame.
As stated above, the ruptured balloon catheter shaft containing a few centimeters of a short seg- ment remained attached to the entrapped balloon. The ruptured balloon catheter shaft extended a few centimeters into the aortic root. A goose neck snare was successfully used to retrieve the remaining prox- imal piece of the ruptured balloon catheter shaft out of the aortic root. A pulling force was again applied on the snare to facilitate the passage and retrieval of the entrapped balloon in-between the surgical post and the SAPIEN 3 frame. A second rupture occurred just outside of the surgical post and SAPIEN 3 frame, resulting in no movement of the entrapped deflated winged balloon (Figure 6B).
Access was lost to the partially, yet firmly, en- trapped balloon inside the left main stent and in-be- tween the surgical frame post and the SAPIEN 3 frame with no wire access. Attempting to wire the left main stent through a superior strut and next to the entrapped balloon was discussed. The strut was dil- atated and another stent was deployed. This caused crushing of the entrapped balloon between two lay- ers of the left main stent with the second stent ex- tending further out in a vertical chimney fashion. This granted easy access to the left coronary system. Due to various reasons the left main stent was unable to be wired through a superior stent strut. This was due to the long distance between the guide catheter and the low left main coronary stent. The guide catheter
Kassas S. et al.
Entrapment of Coronary Stent Catheter in VIV/TAVR