Bioptome-Assisted Blunt Dissection Facilitates Endovascular Retrieval of a Chronically Embolized Stent

We present a 19-year-old female with history of d-transposition of the great arteries status post-arterial switch operation. Due to bilateral proximal pulmonary artery stenoses, she had undergone attempted pulmonary artery stenting at the age of 16. The initial right pulmonary artery (RPA) stent, a 17-mm Valeo (Becton Dickinson), had embolized immediately after implantation to the distal right pulmonary artery with rotation into a cranial-caudal configuration. Flow to all branches coursed through the stent frame with a reduction in distal branch RPA growth in comparison to the left pulmonary artery (LPA) and concern for future thrombotic complications. The patient presented to our hospital for a second opinion, and staged endovascular retrieval of the embolized stent was offered to the patient.

Under general anesthesia, a 22-French DrySeal sheath (Gore) was advanced from the right internal jugular vein to the RPA beyond the proximal stent over an Amplatz Super Stiff wire (Boston Scientific). The embolized stent was stuck between the superior and middle lobe branches of the RPA (Figure, A) (Video). Using a Raptor grasping device (Steris), the tip of the stent was secured, and traction was maintained throughout the procedure (Figure, B). Using a Radial Jaw 4 bioptome (Boston Scientific), blunt dissection of the stent from the arterial wall was performed (Figure, C-E) to mobilize the stent frame. The stent was gradually captured in the sheath and removed intact (Figure, F & G). A dissection flap with flow limitation was noted at ostium of the middle lobe branch of the RPA (Figure, H). A balloon-tipped catheter was advanced to the dissection site and inflated for 1 minute. Repeat angiogram demonstrated no evidence of dissection or perforation with good antegrade flow (Figure, I). The patient was observed overnight with no issues and discharged the following morning.

This novel technique of blunt dissection using a bioptome forceps facilitated retrieval of a chronically embolized stent. The utility of the Raptor grasping device in maintaining control of the stent was highly advantageous in retrieval.

Affiliations and Disclosures

From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Jason H. Anderson, MD, 200 1^st St SW, Rochester, MN 55905, USA. Email: anderson.jason@mayo.edu