Left main stenting with stent dislodgement and entrapment in the common femoral artery: a successful transcatheter stent retrieval.

Proximal left main stenting in symptomatic patients with flow-limiting stenosis is an alternative revascularization strategy in individuals with low syntax score and high operative risk. Stent dislodgement is associated with adverse cardiovascular events and retrieval of fully deployed stents is generally prohibited as it increases the risk of severe complications. Stent dislodgement and entrapment in the femoral vascular system occur infrequently during percutaneous coronary interventions. In this report, we illustrate a prompt and safe transcatheter technique to successfully retrieve an expanded and dislodged coronary stent entrapped in the common femoral artery without need for a more invasive surgical approach.

Use of the PercuSurge GuardWire distal balloon occlusion system as an endovascular clamp during off-pump coronary bypass surgery with the LIMA to the LAD.

Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the potential to reduce perioperative morbidity. Current techniques of snaring or inserting a shunt into the coronary artery to occlude flow and allow for anastomotic construction carry the risk of vessel trauma and subsequent graft failure. We present two cases in which PercuSurge GuardWires were used as an endovascular clamp in a hybrid operating room/catheterization laboratory to transiently occlude flow down the native left anterior descending artery during left internal mammary artery anastamotic construction.

Release and elimination of soluble vasoactive factors during percutaneous coronary intervention of saphenous vein grafts: analysis using the PercuSurge GuardWire distal protection device.

BACKGROUND: The presence of no-reflow substantially increases the risk of major adverse clinical events (MACE) in percutaneous coronary artery interventions (PCI). Distal protection devices may eliminate both debris and soluble factors that can lead to no-reflow. This study was designed to evaluate the soluble factors released and eliminated by the PercuSurge GuardWire during SVG intervention. METHODS: Twenty-eight consecutive patients underwent PCI on 34 lesions in 31 SVGs using the PercuSurge GuardWire. Blood was taken prior to PCI for baseline measurement of: (1) vasoconstrictive factors: endothelin (ET) and serotonin (5-HT); (2) thrombotic factors: tissue factor (TF), plasminogen activator inhibitor (PAI-1), thrombin/antithrombin III complex (TAT), and prothrombin fragment F1+2 (F1+2); and (3) inflammatory factors: soluble CD40 ligand (sCD40L) and soluble E-selectin. After stenting and before deflating the distal protection balloon, 2 aspiration runs were performed with the PercuSurge Export Catheter and sent for analysis. RESULTS: Clinical follow-up was conducted at an average of 6 +/- 3 months. SVG PCI resulted in a substantial increase in levels of vasoconstrictive factors, including ET (3 x increase; p < 0.001) and 5-HT (9.7 x increase; p = 0.031); thrombotic factors, including TF (4.5 x increase; p = 0.005), TAT (2.4 x increase; p < 0.001), and F1+2 (2.4 x increase; p < 0.001). Pro-inflammatory factors were also released during the procedure. Levels of sCD40L and soluble E-selectin increased 123% (p = 0.003) and 25% (p < 0.001), respectively. CONCLUSIONS: SVG PCI results in an immediate increase in vasoactive factors, including vasoconstrictive, thrombotic and inflammatory factors. The PercuSurge GuardWire effectively removes these soluble factors, which may account for reduction of no-reflow and other complications during SVG interventions.