Carotid sheath rescue with a distal filter retrieval catheter.
Sheath placement prior to carotid artery stenting is usually uncomplicated, and provides sufficient support for the procedure. In certain patients, especially those with unfavorable arch anatomy, tortuous vessels, and heavily calcified lesions, the sheath backs out into the aortic arch with compromise of wire and embolic protection device (EPD) position, and risk of "dragging" the EPD back through the lesion. A novel use of the distal filter retrieval catheter to "rescue" a prolapsed guide sheath is described. Use of the filter retrieval catheter as a "body" to retrack the sheath but not recapturing the deployed filter is a useful technique, since the equipment is already available. This avoided the need to pull a retrieved filter through a severe undilated carotid stenosis, reducing the amount of manipulations needed to reposition the sheath and thus reducing the risk of embolic events.
Chiam
Paul T L
PT
Department of Cardiac and Vascular Interventional Services, Lenox Hill Heart and Vascular Institute of New York, New York 10021, USA.
Roubin
Gary S
GS
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D004867:Equipment Design; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D011859:Radiography; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome