PMID- 29324372
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2210-2612 (Print)
IS  - 2210-2612 (Electronic)
IS  - 2210-2612 (Linking)
VI  - 42
DP  - 2018
TI  - Dislocation of a cerebral protection device component during carotid stenting: A 
      case report of favorable outcome from conservative management after failure of 
      retrieval.
PG  - 254-257
LID - S2210-2612(17)30684-3 [pii]
LID - 10.1016/j.ijscr.2017.12.032 [doi]
AB  - INTRODUCTION: Cerebral-protection devices (CPDs) are a well-established system 
      for reduction of embolic risk in carotid artery angioplasty and stenting (CAS). 
      Although rare, adverse events with CPDs are unpredictable and can be associated 
      with serious outcomes and iatrogenic sequelae. PRESENTATION OF CASE: We describe 
      the unique case of dislocation of a FilterWire EX filter loop during right CAS. 
      On trying to recapture the CPD filter at the end of the procedure, the filter 
      loop suddenly detached from the guidewire and dislocated to the proximal middle 
      cerebral artery. Attempted retrieval of the loop failed and the patient developed 
      a transient neurological deficit caused by an acute ischemic infarction in the 
      lenticular nucleus. No further retrieval attempt was pursued. No further 
      dislocation of the loop or clinical event have been reported during the 16-year 
      follow up. DISCUSSION: This case reported a favorable outcome of conservative 
      management for entrapped material from a CPD after iatrogenic damage from failed 
      retrieval. No similar reports are available in the literature, and conservative 
      management is generally not a recommended approach because of the potential 
      complications. However, rescue retrieval attempts are as well a potential source 
      of serious events, and no clear guidelines exist on the management of mechanical 
      complications from CPD. CONCLUSION: Entrapment of CPD components constitutes an 
      adverse event with no unique solution for risk-free management. The potential 
      risks associated with the use of protection devices are still to be fully 
      explored, and improving the standard of care and patient safety needs to be a top 
      priority.
CI  - Copyright (c) 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Tocco-Tussardi, Ilaria
AU  - Tocco-Tussardi I
AD  - Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University 
      Hospital of Padova, Padova, Italy; Clinic of Plastic and Reconstructive Surgery, 
      Department of Neurosciences, University of Padova, Padova, Italy. Electronic 
      address: ilaria.toccotussardi@gmail.com.
FAU - Kulyk, Caterina
AU  - Kulyk C
AD  - Clinic of Neurology, Department of Neurosciences, University Hospital of Padova, 
      Padova, Italy.
FAU - Vindigni, Vincenzo
AU  - Vindigni V
AD  - Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, 
      University of Padova, Padova, Italy.
FAU - Avruscio, Giampiero
AU  - Avruscio G
AD  - Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University 
      Hospital of Padova, Padova, Italy.
LA  - eng
PT  - Journal Article
DEP - 20171228
PL  - Netherlands
TA  - Int J Surg Case Rep
JT  - International journal of surgery case reports
JID - 101529872
PMC - PMC5766750
OTO - NOTNLM
OT  - Angioplasty
OT  - Carotid artery stenting
OT  - Cerebral protection device
OT  - Iatrogenic disease
OT  - Mechanical complication
OT  - Stroke
EDAT- 2018/01/13 06:00
MHDA- 2018/01/13 06:01
PMCR- 2017/12/28
CRDT- 2018/01/12 06:00
PHST- 2017/10/16 00:00 [received]
PHST- 2017/12/14 00:00 [accepted]
PHST- 2018/01/13 06:00 [pubmed]
PHST- 2018/01/13 06:01 [medline]
PHST- 2018/01/12 06:00 [entrez]
PHST- 2017/12/28 00:00 [pmc-release]
AID - S2210-2612(17)30684-3 [pii]
AID - 10.1016/j.ijscr.2017.12.032 [doi]
PST - ppublish
SO  - Int J Surg Case Rep. 2018;42:254-257. doi: 10.1016/j.ijscr.2017.12.032. Epub 2017 
      Dec 28.