Bailout technique to remove a distal protection device (‘Filtrap’) when the retrieval and delivery catheters could not pass through the deployed stent

Introduction

Although aspiration thrombectomy might be considered only in patients with ST-segment elevation myocardial infarction (STEMI) according to the European Society of Cardiology guidelines, small studies showed that aspiration thrombectomy and/or distal embolic protection might be effective to prevent slow flow/no flow during percutaneous coronary intervention (PCI) in non ST-segment elevation myocardial infarction (NSTEMI) patients with thrombus or attenuated plaque according to Japanese Circulation Society (JCS) Guidelines for management of acute coronary syndrome without persistent ST-segment elevation [1–6]. Distal embolic protection should be considered in NSTEMI patients with thrombus or attenuated plaque in Japan, which is supported by these Guidelines. However, data to support distal protection in STEMI/NSTEMI are scarce, and this technique is not broadly adopted elsewhere [1, 2]. Either occlusive or filter-based systems can catch thrombus and/or debris that may damage distal tissue. Their insert packages recommend aspiration in the culprit lesion before removal to prevent distal embolism on removal. A filter-based device (Filtrap, Nipro, Japan) was designed to capture debris while preserving coronary blood flow and making the procedure simple and smooth [5, 6].
In this article, we present a bailout technique to remove the Filtrap device when the retrieval and delivery catheters could not pass through the deployed stent.

Case report

A 72-year-old Japanese man visited the outpatient clinic of our institution because of frequent chest pain. He was diagnosed with NSTEMI because his electrocardiogram demonstrated that the ST segments in V5-6 were depressed and the laboratory test on admission showed that troponin I was increased. Coronary angiography (CAG) revealed severely stenotic lesions in the left anterior descending coronary artery (LAD) (Figure 1 A). He underwent PCI for the LAD lesion. A 6.5-Fr TYPE-M SheathLess guiding catheter (Asahi intecc, Japan) was positioned in the left main tract by the procedure described previously [7, 8]. After wiring into the LAD with a Sion blue guidewire (Asahi intecc, Japan), we evaluated the culprit lesion by Navifocus WR intravascular ultrasound (IVUS) (Terumo, Japan). A distal protection device (Filtrap) was deployed at the distal site of the culprit lesion because IVUS showed attenuated plaque (Figure 1 B). After pre-dilatation was performed using a 3.0 × 13 mm Lacrosse...


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