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
- Bioptome* (Cook medical)
- Needle and eye snare
- Multi snare
- Welter loop catheter
- Expo retrieval catheter
- Curry snare
- Simple alternate option : 2 or three wire guide wire trapping technique.
- 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
Dr.S.Venkatesan MD 