Desai Chirag K, Petrasko Marian, Steffen Kelly, Stys Tomasz, Stys Adam
UNIVERSITY OF SOUTH DAKOTA SANFORD SCHOOL OF MEDICINE, SIOUX FALLS, SOUTH DAKOTA.
Methodist Debakey Cardiovasc J. 2019 Jan-Mar;15(1):81-85. doi: 10.14797/mdcj-15-1-81.
The entrapment of coronary intervention devices within the coronary vasculature is a rare but potentially devastating procedural complication. We report a case of an entrapped balloon and broken shaft that had to be retrieved by an open surgical approach. When device extraction is indicated and the use of snaring equipment is unsuccessful or inappropriate, a number of alternative percutaneous maneuvers can be attempted. These include (1) simple advancement and withdrawal of a trapped balloon, (2) use of a "buddy" wire to straighten the vessel and free the trapped device, (3) inflation of a buddy balloon adjacent to a trapped primary balloon to free the device, (4) partial inflation of a buddy balloon distal to a trapped device followed by gentle withdrawal, (5) use of an in-guide secondary balloon to trap the lost device, (6) advancement and twisting of guidewires to entwine the lost device, (7) saline dilution of trapped balloons, and (8) anchoring balloon and reverse-wire puncture of an undeflated and entrapped primary balloon. Careful consideration of various device retrieval strategies is indicated before resorting to open surgical retrieval in the rare instance of intracoronary device entrapment.
冠状动脉介入器械被困在冠状动脉系统内是一种罕见但可能具有毁灭性的手术并发症。我们报告了一例被困球囊和折断导管的病例，该病例必须通过开放手术方法取出。当需要取出器械且使用圈套设备不成功或不合适时，可以尝试一些替代的经皮操作。这些操作包括：（1）简单地推进和回撤被困球囊；（2）使用“伙伴”导丝拉直血管并释放被困器械；（3）在被困主球囊旁边充盈一个伙伴球囊以释放器械；（4）在被困器械远端部分充盈伙伴球囊，然后轻轻回撤；（5）使用导引导管内的辅助球囊捕获丢失的器械；（6）推进并扭转导丝以缠绕丢失的器械；（7）用盐水稀释被困球囊；（8）锚定球囊并对未充盈且被困的主球囊进行反向导丝穿刺。在冠状动脉内器械被困这种罕见情况下，在采取开放手术取出之前，应仔细考虑各种器械取出策略。
