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Use of rotablation to rescue a “fractured” micro catheter tip: A case report

World Journal of Cardiology 2019年第7期11卷 189-194页

作者： Mohammad Alkhalil Conor McQuillan Michael Moore Mark S.Spence colum owens Cardiology Department Royal Victoria HospitalBelfast BT12 6BAUnited Kingdom Cardiology Department Craigavon Area HospitalPortadown BT63 5QQUnited Kingdom

BACKGROUND High-speed rotational atherectomy (HSRA) is most commonly used to modify calcified coronary artery lesions to facilitate stent deployment and expansion. The use of HSRA as an emergency rescue technique to release a fractured microcatheter has not been described. We report the use of HSRA in a case of a fracture trapped corsair tip that was impeding coronary flow causing a ST elevation myocardial infarct. CASE SUMMARY A 79 years old male was scheduled for elective percutaneous coronary intervention (PCI) to his left anterior descending artery (LAD). Given its calcific nature, a decision was made for upfront rotablation. During procedural preparations, the tip of an employed micro-catheter was separated from the shaft resulting in obstructing coronary flow and ST-segment elevation. The consensus was for an attempt bail out PCI strategy. A rotafloppy wire was advanced to the distal LAD using a corsair micro-catheter which was placed proximal to the occlusion site. Modification of the mid LAD segment was performed, resulting in mobilising the corsair tip, and deflecting it to a small diagonal branch. Following serial predilation, the procedure was completed using two overlapping drug eluting stents, jailing the corsair tip in the diagonal branch. The patient made uneventful recovery and was clinically stable at one year follow up. CONCLUSION HSRA may be offered as a bailed-out strategy to rescue fractured and jailed micro-catheter tip in high risk surgical cases.

关键词： Micro-catheter Rotational atherectomy Calcification Case report

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