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Failed Manta Closure Device After High-Risk PCI
Abstract
J INVASIVE CARDIOL 2022;34(1):E69-E70.
Key words: cardiac imaging, chronic total occlusion, intra-aortic balloon pump, percutaneous coronary intervention
Case Presentation
A 60-year-old female patient was hospitalized with chest pain, ST-depressions on electrocardiogram, and new-onset heart failure with reduced ejection fraction (EF) of 20% to 25%. She was diagnosed with high-risk non-ST segment elevation myocardial infarction (NSTEMI). A coronary angiogram demonstrated 95% distal left main (LM) disease involving the left anterior descending artery and left circumflex artery, and a chronic total occlusion (CTO) of the right coronary artery (RCA) (Figure 1). A left femoral intra-aortic balloon pump (IABP) was placed in anticipation of coronary artery bypass graft surgery, but the patient was deemed a poor surgical candidate for cardiothoracic surgery due to poor conduits. Given a low cardiac index (2.18 L/min/m2), low EF, complex unprotected LM requiring a 2-stent strategy, need for atherectomy, and a CTO of the RCA, the patient’s IABP was upgraded to an Impella CP (Abiomed). The patient underwent successful percutaneous coronary intervention (PCI) using a double-kissing crush technique. The Impella CP was weaned and removed, and the left femoral artery was closed using a Manta closure device (Teleflex). The closure was uncomplicated, but final femoral angiography demonstrated persistent bleeding. Despite 60 minutes of balloon tamponade and intermittent manual pressure, bleeding persisted (Figure 2 and Figure 3). Given the difficulty achieving hemostasis, the patient underwent urgent surgical intervention with endarterectomy of the common femoral artery. Plaque on the lateral aspect of the femoral artery resulted in failed apposition of the collagen plug with the femoral artery. An 8 mm x 8 cm bovine pericardial patch was delivered with successful hemostasis.
Although the collagen-based Manta closure device is a safe and effective option to close large-bore arterial access sites, complications can occur in at-risk cohorts, as seen in this clinical scenario. It is important for clinicians to share these complications as new technology is introduced.
Affiliations and Disclosures
From the 1Department of Cardiology, 2Department of Vascular Surgery, Henry Ford Hospital, Detroit, Michigan.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted August 18, 2021.
The authors report patient consent for the images used herein.
Address for correspondence: Hussayn Alrayes, DO, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202. Email: halraye1@hfhs.org
References
1. Gupta A, Fouad L, Basir M, et al. Safety and effectiveness of MANTA vascular closure device after large-bore mechanical circulatory support: real-world experience. Cardiovasc Revasc Med. 2020;21:875-878.
2. Moccetti F, Brinkert M, Seelos R, et al. Insights from a multidisciplinary introduction of the MANTA vascular closure device. JACC Cardiovasc Interv. 2019;12:1730-1736.
