使用血管内钳取出位置不当的封堵器装置。

Extracting a Malpositioned Occluder Device Using Endovascular Forceps.

作者信息

Roy Sumon, Bakhshi Hooman, Aziz Hamza, Hasan Rani

机构信息

Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Cardiology, Boston Medical Center Health System, Boston, Massachusetts, USA.

Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

JACC Case Rep. 2025 Aug 6;30(22):104639. doi: 10.1016/j.jaccas.2025.104639.

DOI:10.1016/j.jaccas.2025.104639

PMID:40780772

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12426511/

Abstract

BACKGROUND

Transcatheter left atrial appendage occlusion (LAAO) is a low-risk procedure with a <1.0% risk of malposition.

CASE SUMMARY

An 80-year-old man with atrial fibrillation intolerant to apixaban underwent implantation of a 24 mm Watchman FLX device (Boston Scientific), which immediately shifted, exposing uncovered metal in the left atrium. Four weeks later, an AngioVac F22 catheter (AngioDynamics) was advanced into the left atrium and a 10-mm Raptor grasping forceps (Steris) was introduced via the AngioVac catheter. Using the Raptor, the Watchman FLX was grasped and with cautious, sustained force extracted into the AngioVac (Video 1) and out of the body intact (Figure 1). A 28 mm Amulet device (Abbott) was then implanted.

DISCUSSION

While alternative approaches to LAAO device retrieval have been described, this is to our knowledge the first report describing the use of an AngioVac catheter to extract a malpositioned Watchman FLX (Video 2) and achieving successful LAAO by replacement with an Amulet.

TAKE-HOME MESSAGE: Implanting proceduralists must be equipped to salvage high-risk complications such as device malposition.

摘要

背景

经导管左心耳封堵术（LAAO）是一种低风险手术，器械位置不当的风险<1.0%。

病例摘要

一名80岁男性，患有房颤，对阿哌沙班不耐受，接受了24毫米Watchman FLX装置（波士顿科学公司）的植入，该装置立即发生移位，左心房出现未覆盖的金属部分。四周后，将一根AngioVac F22导管（AngioDynamics公司）推进左心房，并通过AngioVac导管引入一把10毫米的Raptor抓钳（史赛克公司）。使用Raptor抓钳抓住Watchman FLX，小心翼翼地持续用力将其拉入AngioVac（视频1），并完整地取出体外（图1）。随后植入了一个28毫米的Amulet装置（雅培公司）。