Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Nov 24;9(1):386-390.
doi: 10.1002/ccr3.3538. eCollection 2021 Jan.

Coronary sinus reducer transfemoral extraction after intraprocedural device migration: A case report

Matjaz Bunc  1 , Miha Sustersic  1 , Crt Langel  2 , Dimitrij Kuhelj  2 , Shmuel Banai  3
Affiliations
Case Reports

Coronary sinus reducer transfemoral extraction after intraprocedural device migration: A case report

Matjaz Bunc et al. Clin Case Rep. .

Abstract

The coronary sinus reducer migration during implantation procedure is a rare complication with no standard bailout strategy. Transfemoral extraction of the reducer can be a safe and successful method, as demonstrated by this case report.

Keywords: coronary sinus; device migration; reducer; refractory angina; snare; transfemoral extraction.

PubMed Disclaimer

Conflict of interest statement

Shmuel Banai is the Medical Director of Neovasc, Inc. The other authors have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Coronary sinus reducer implantation and its extraction to the right atrium. A, Coronary sinus venography. Also visible is the surgical material after coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). Amplatz extra support wire and the guiding catheter are inserted in the CS. B, The reducer stent with tree markers inside the guide catheter. C, Proximal angiography showing no contrast leak after balloon inflation up to 6 atm. D, Guiding catheter extraction to the right atrium with the migrated reducer stent attached to the tip of the catheter. E, A close up of the slightly deformed reducer stent after pullout to the right atrium
FIGURE 2
FIGURE 2
Right femoral vein snare extraction of the reducer: A, the reducer extracted to the right atrium near the ostium of vena cava superior, fixed on guiding catheter. The guidewire is still inside the CS; B, guidewire redirection into the vena cava inferior, toward the right femoral vein. C and D, right femoral vein cannulation and 16F sheet (St. Jude Medical Inc, St. Paul, MN) introduction; E, a snare with an open lasso sliding on the guidewire; F, a snare grasping the guiding catheter and the reducer; G and H, pulling of the snare and simultaneous pushing of the guiding catheter into the right femoral vein sheet; I, final extraction of the reducer through the right femoral vein sheet, followed by the displacement of the sheet and closure of the femoral vein with an "8" suture (not depicted)
FIGURE 3
FIGURE 3
Implantation of a second reducer a few millimeters more distal to the landing zone of the first reducer (A and B), with expansion and the final result (C and D)
See this image and copyright information in PMC

References

    1. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407‐477. - PubMed
    1. Verheye S, Jolicœur EM, Pettersson T, et al. Efficacy of a device to narrow the coronary sinus in refractory angina. N Engl J Med. 2015;372(6):519‐527. - PMC - PubMed
    1. Konigstein M, Giannini F, Banai S. The Reducer device in patients with angina pectoris: mechanisms, indications, and perspectives. Eur Heart J. 2018;39(11):925‐933. - PubMed
    1. Tzanis G, Palmisano A, Gallone G, et al. The impact of the coronary sinus reducer upon left ventricular function in patients with refractory angina pectoris. Catheter Cardiovasc Interv. 2020;95:1104‐1108. - PubMed
    1. Palmisano A, Giannini F, Rancoita P, et al. Feature tracking and mapping analysis of myocardial response to improved perfusion reserve in patients with refractory angina treated by coronary sinus Reducer implantation: a CMR study. Int J Cardiovasc Imaging. 2020. ahead of print. 10.1007/s10554-020-01964-9 - DOI - PubMed

Publication types

LinkOut - more resources