Dr.S.Venkatesan MD

We are aware  , modern day cardiologists literally live within the patients coronary artery and vascular system .  It ‘s not at all surprising then , man made cardio vascular accidents  are becoming more common  , where pieces of hard ware like guide wires catheters and stents  get trapped .

Knowing about the hardware and techniques of retrieval of foreign bodies within vascular system is so important .It would appear  indulging in cath lab work with out proper salvage hardware and expertise is a  near  serious offense.Apart from this , many complex procedures require intentional snaring of wires and gadgets .

How to retrieve a foreign body from  coronary artery ?

There are few snares availablew  with  single or multiple loops  and comes in various sizes .

1.Goose neck EV3 snare (Covidien /Medtronic)

2.En snare -Multiple loops (Merit Medica)

3.Micro elite snare (Vascular solutions)

The snare is constructed of Nitinol cable and a gold plated tungsten loop. The pre-formed snare loop can be introduced through catheters without risk of snare deformation because of the snare’s super-elastic construction. The snare catheter contains a platinum-iridium radio opaque marker band.

• Nitinol Shaft for durability and kink resistance
• Super-elastic and shape memory properties of nitinol provide kink resistance.
• Ideal for challenging or unplanned foreign body retrieval and manipulation cases.

True 90° snare loop remains coaxial to the lumen

• Snare loop forms a true 90° angle.
• Device remains coaxial to the lumen for proper insertion and successful retrieval or manipulation of atraumatic foreign bodies.

Hardware specification

2.Ensnare

Micro elite snare

Other retrieval devices

1. Bioptome* (Cook medical)
2. Needle and eye snare
3. Multi snare
4. Welter loop catheter
5. Expo retrieval catheter
6. Curry snare
7. Simple  alternate option : 2 or three wire guide wire trapping  technique.
8. The cheapest option :To make a custom made snare with  .014 PTCA   guidewire  with a flexible loop .

Intra cardiac biopsy forceps may help to retrieve some of the foreign bodies

Final message

At least few of  these retrieval devices  should be  available in  every cath lab .  Attempting to do sophisticated procedures  in your cath lab without essential hardware is akin to driving a car with defective breaks  or like flying airplane with a single engine .

Acknowledgement

Image source , content and courtesy respective manufacture web site