Coronary Sinus Reducer Transfemoral Extraction After Intraprocedural Device Migration to the Pulmonary Artery

Abstract

J INVASIVE CARDIOL 2022;34(4):E345.

Key words: device migration, pulmonary artery

Case Presentation

An 84-year-old male presented with refractory angina despite optimal medical treatment and multiple coronary revascularization procedures. Coronary sinus (CS) reducer implantation was programmed.

A multipurpose (MP) catheter was introduced in the CS via internal jugular vein access with a 9-Fr sheath and angiography confirmed suitable anatomy (Figure 1A). A 0.035˝ guidewire was advanced distally in the CS to deliver the guiding catheter and reducer device to the landing zone. However, during the guiding catheter retrieval, we observed the stent outside and distal to the balloon (Figure 1B). Although we attempted to maintain the wire inside the stent, during the retrieval of the balloon catheter, the unexpanded stent migrated to the pulmonary artery (Figure 1C).

An 11-Fr sheath was advanced to the pulmonary artery over a 0.035˝ guidewire through a femoral vein. The reducer was snared and extracted without complications (Figure 1D). A second reducer device was implanted using a mother-and-child technique, advancing the guiding catheter of the 9-Fr device through a 5-Fr multipurpose catheter (Figure 1E). After advancing the guiding catheter more distally to the landing zone, we retrieved the MP catheter and delivered the reducer with successful implantation (Figure 1F).

CS reducer migration during implantation is an unusual complication with no standard bail-out strategy. To the best of our knowledge, there is no description of migration to the pulmonary artery. A mother-and-child technique during implantation could be the safest way to avoid this complication.

Affiliations and Disclosures

From the Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Jimènez-Valero reports consulting fees from World Medica. The remaining authors report no conflicts of interest regarding the content herein.

Manuscript accepted December 10, 2021.

Address for correspondence: Andrea Severo, MD, La Paz University Hospital, Paseo de la Castellana, 261 28046 – Madrid, Spain. Email: andreados@hotmail.com