Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2019; 11(7): 189-194
Published online Jul 26, 2019. doi: 10.4330/wjc.v11.i7.189
Use of rotablation to rescue a “fractured” micro catheter tip: A case report
Mohammad Alkhalil, Conor McQuillan, Michael Moore, Mark S. Spence, Colum Owens
Mohammad Alkhalil, Conor McQuillan, Mark S. Spence, Colum Owens, Cardiology Department, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
Michael Moore, Cardiology Department, Craigavon Area Hospital, Portadown BT63 5QQ, United Kingdom
Author contributions: Alkhalil M conceptualised, collected and analysed data, drafted the manuscript; McQuillan C collected and analysed data, reviewed the manuscript; Moore M provided resources, reviewed and edited the manuscript; Spence M supervised, reviewed and edited the manuscript; Owens C supervised, reviewed and edited the manuscript.
Informed consent statement: The patient has provided consent for publication.
Conflict-of-interest statement: None.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohammad Alkhalil, DPhil, MRCP, Doctor, Cardiology Department, Royal Victoria Hospital, 274 Grosvenor Road, Belfast BT12 6BA, United Kingdom. mak-83@hotmail.com
Telephone: +44-2890-240503
Received: January 30, 2019
Peer-review started: January 31, 2019
First decision: April 15, 2019
Revised: April 22, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: July 26, 2019
Processing time: 178 Days and 0.4 Hours
Abstract
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 micro-catheter 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.

Keywords: Micro-catheter, Rotational atherectomy, Calcification, Case report

Core tip: Fractured micro-catheter tip impeding flow has not been previously described. With aging population and increasing calcification, this phenomenon is likely to face interventional cardiologists in the future. Non-surgical bailed-out strategy to rescue the trapped tip is described in the current case.