Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
Taishi HiraiJohn E A Blair

Abstract

A 68-year-old female with a history of coronary artery disease and prior bypass surgery presented for staged percutaneous coronary intervention (PCI) to a calcified and angulated ostial left circumflex (LCX) artery lesion after PCI of the anastomosis of the left internal mammary artery - to left anterior descending artery. Orbital atherectomy of the LCX was performed at a speed of 80,000 RPM with multiple passes, and was complicated by device microtip dislodgement and entrapment within the vessel. After advancing a "buddy" wire beyond the microtip, a tapered microcatheter was advanced over the ViperWire and into the edge of the broken microtip and torqued into the microtip with forward pressure using the 0.014 in ViperWire tip as a "backstop." The guidewire, microcatheter, and microtip were then successfully removed as a unit and the intervention with stent placement was completed over the "buddy" wire. Scanning electron microscopy of the shaft revealed evidence of cyclic fatigue, indicating that the fracture occurred while spinning. The fracture when performing atherectomy in a model coronary artery with a radius of approximately 6 mm. This represents a first case of microtip dislodgement and entrapment during the use of a cor...Continue Reading

References

Jan 8, 2000·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·H KanedaY Hiroe
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Feb 26, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Takenori KanazawaKazuaki Mitsudo
Dec 10, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Yutaka Tanaka, Shigeru Saito
Jul 1, 2016·Journal of Interventional Cardiology·Michael S LeeRichard Shlofmitz

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Citations

Jul 22, 2020·Cardiovascular Intervention and Therapeutics·Kanichi OtowaKazuo Usuda
Apr 2, 2021·Heart·Emanuele Barbato
Jan 6, 2021·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Peter TajtiKambis Mashayekhi

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