2022/5/7 CVIT地方会

1. A case of anterior NSTEMI
with displacement of the 3rd generation SES.
Dept. of Cardiology, Tokyo General Hospital, Japan
Yukihiro Yamaguchi, Reiko Tsukahara,
Toshiya Muramatsu, Masatsugu Nakano,
Hideyuki Takimura, Mami Kawano,
Emi Tajima, Tsuzuki Ippei,
Rintaro Taniguchi, Kurozumi Atsumasa
第59回 CVIT 関東甲信越地方会 2022

2. the Japanese Association of
Cardiovascular Intervention and Therapeutics
COI Disclosure
Yukihiro Yamaguchi
The authors have no financial conflicts of interest
to disclose concerning the presentation.

3.  Diagnosis: NSTEMI
 Prior intervention:
’17/9 AP (seg.3 EES)
’17/9 AP (seg.5-7 EES)
’17/10 AP (seg.14 EES)
’21/3 AP (seg.11 BP-EES)
 Coronary risk factor: HT, HL, OCI
 eGFR: 54 (mL/min/1.73m2)
 LVEF 62 % (UCG)
Dept. of Cardiology, Tokyo General Hospital, Japan
RAO 10° CRA 30°

4. D2
LCX
①
②
③
① ② ③
LAD
LAD
LM
Lesion Angle 140°
①
Eccentric calcification
②
Eccentric calcification in seg. 5-6
④
④
⑤
③ ④ ⑤
⑤
LAD
RAO 10° CRA 30°

5. Dept. of Cardiology, Tokyo General Hospital, Japan
RAO 30°CRA 35°
Approach: Lt. Radial A. 6Fr
Guide catheter: 6Fr EBU3.5 (SH)
Guide wire: Run through ultra floppy, Run through hypercoat
Balloon: SCB 2.5*15mm
AltaView
Pre-IVUS imaging
RAO 10° CRA 30°

6. Stent deplacement
RAO 10°CRA 35°
Dept. of Cardiology, Tokyo General Hospital, Japan
U-SES 2.5*21 mm

7. Bail out 1st try - Balloon
SCB 2.0*15mm
Dept. of Cardiology, Tokyo General Hospital, Japan
RAO 15°CRA 30°
RAO 15°CRA 30°
RAO 10°CRA 40° For 5 minutes

8. Bail out 2nd try - Balloon
Dept. of Cardiology, Tokyo General Hospital, Japan
SCB 1.5*15mm
RAO 10°CRA 40°
RAO 10°CRA 40°
RAO 10°CRA 40°
For 8 minutes

9. Bail out 3rd try – EN snare®
Dept. of Cardiology, Tokyo General Hospital, Japan
EN snare®

10. Succesful bail out – with EN snare®
Lt. Radial A.
LAO30°CRA20°
Dept. of Cardiology, Tokyo General Hospital, Japan
RAO 10°CRA 40°
For 20 minutes

11. U-SES 2.5*28mm
Stenting and post-IVUS imaging
Dept. of Cardiology, Tokyo General Hospital, Japan
Extension catheter (GUIDEZILLA™ II )
Final CAG
CRA 30°
CRA 30°

12. Discussion
Dept. of Cardiology, Tokyo General Hospital, Japan
• In this case, I think you should have considered putting the stent in there.
• ONE snare™ would be more useful for stent retrieval.
• When you use ONE snare™, grasp the front of the stent. If the middle of the
stent is grasped, it will be deformed into a V shape and cannot be retracted
into the guiding catheter.

13. ONE Snare™
Dept. of Cardiology, Tokyo General Hospital, Japan
ONE Snare™

14. Summary
Dept. of Cardiology, Tokyo General Hospital, Japan
• It is important that patients do not die.
• Think of the easiest bail out for YOU. Do not overdo it.
• The 3rd generation stent also drops out. It is not an old story.
• Never pull out the WIRE.
• In this case, we think you should have considered putting a stent in there.
• EN snare® and ONE snare™ are also useful for stent retrieval. Place one at each
hospital.
• Once the stent has moved from the aorta to the periphery, it should be retrieved
calmly.