How to retrieve a ruptured micro-catheter tip stuck in a tight lesion?
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ABSTRACT:
SUBMITTER: Shitan H
PROVIDER: S-EPMC8086501 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
Publications
How to retrieve a ruptured micro-catheter tip stuck in a tight lesion?
Shitan Hidemasa H Hachinohe Daisuke D Kashima Yoshifumi Y Fujita Tsutomu T
Cardiology journal 20200101 1
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Project description:BackgroundCentral venous catheters may become embedded due to the formation of adhesions between the indwelling catheter and the vein wall.Case presentationA 49-year-old patient with bacteraemia was referred for retrieval of an embedded internalised central venous dialysis catheter. Recently the catheter had been surgically ligated at the venotomy site internalising the intravascular catheter component, which precluded antegrade ballooning through the catheter hub. Seldinger technique was used to access the catheter lumen within the left internal jugular vein and through and through access was established across the catheter. Retrograde endoluminal balloon dilation was performed to disrupt adhesions and free the catheter. The catheter was snared over the wire and removed from the right femoral vein.ConclusionThis case report outlines an effective, minimally invasive retrieval method in a rare case of an embedded internalised central venous catheter.
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Project description:Transcatheter closure of patent ductus arteriosus is the standard of care. Retrieval of a duct occluder device is generally easy until it is detached from the delivery cable. We report two instances of failed retrieval of the device due to sheath tip invagination. The report highlights the importance of prompt identification of the mechanism of unforeseen complications in managing them effectively.
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Project description:ObjectivesChest X-ray (CXR) is routinely required for assessing Central Venous Catheter (CVC) tip position after insertion, but there is limited data as to the movement of the tip location during hospitalization. We aimed to assess the migration of Central Venous Catheter (CVC) position, as a significant movement of catheter tip location may challenge some of the daily practice after insertion.Design and settingsRetrospective, single-center study, conducted in the Intensive Care and Cardiovascular Intensive Care Units in Tel Aviv Sourasky Medical Center 'Ichilov', Israel, between January and June 2019.PatientsWe identified 101 patients with a CVC in the Right Internal Jugular (RIJ) with at least two CXRs during hospitalization.Measurements and resultsFor each patient, we measured the CVC tip position below the carina level in the first and all consecutive CXRs. The average initial tip position was 1.52 (±1.9) cm (mean±SD) below the carina. The maximal migration distance from the initial insertion position was 1.9 (±1) cm (mean±SD). During follow-up of 2 to 5 days, 92% of all subject's CVCs remained within the range of the Superior Vena Cava to the top of the right atrium, regardless of the initial positioning.ConclusionsCVC tip position can migrate significantly during a patient's early hospitalization period regardless of primary location, although for most patients it will remain within a wide range of the top of the right atrium and the middle of the Superior Vena Cava (SVC), if accepted as well-positioned.
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Project description:BackgroundLesion size is reported to become larger as contact force (CF) increases. However, this has not been systematically evaluated in temperature-guided very high-power short-duration (vHPSD) ablation, which was therefore the purpose of this study.MethodsRadiofrequency applications (90 W/4 s, temperature-control mode) were performed in excised porcine myocardium with four different CFs of 5, 15, 25, and 35 g using QDOT-MICRO™ catheter. Ten lesions for each combination of settings were created, and lesion metrics and steam-pops were compared.ResultsA total of 320 lesions were analyzed. Lesion depth, surface area, and volume were smallest for CF of 5 g than for 15, 25, and 35 g (depth: 2.7 mm vs. 2.9 mm, 3.0 mm, 3.15 mm, p < .01; surface area: 38.4 mm2 vs. 41.8 mm2, 43.3 mm2, 41.5 mm2, p < .05; volume: 98.2 mm3 vs. 133.3 mm3, 129.4 mm3, 126.8 mm3, p < .01 for all pairs of groups compared to CF = 5 g). However, no significant differences were observed between CFs of 15-35 g. Average power was highest for CF of 5 g, followed by 15, 25, and 35 g (83.2 W vs. 82.1 W vs. 77.1 W vs. 66.1 W, p < .01 for all pairs), reflecting the higher incidence of temperature-guided power titration with greater CFs (5 g:8.8% vs. 15 g:52.5% vs. 25 g:77.5% vs. 35 g:91.2%, p < .01 for all pairs except for 25 g vs. 35 g). The incidence of steam-pops did not significantly differ between four groups (5 g:3.8% vs. 15 g:10% vs. 25 g:6.2% vs. 35 g:2.5%, not significant for all pairs).ConclusionsFor vHPSD ablation, lesion size does not become large once the CF reaches 15 g, and the risk of steam-pops may be mitigated through power titration even in high CFs.
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Project description:Lesions and neurologic disability in inflammatory CNS diseases such as multiple sclerosis (MS) result from the translocation of leukocytes and humoral factors from the vasculature, first across the endothelial blood-brain barrier (BBB) and then across the astrocytic glia limitans (GL). Factors secreted by reactive astrocytes open the BBB by disrupting endothelial tight junctions (TJs), but the mechanisms that control access across the GL are unknown. Here, we report that in inflammatory lesions, a second barrier composed of reactive astrocyte TJs of claudin 1 (CLDN1), CLDN4, and junctional adhesion molecule A (JAM-A) subunits is induced at the GL. In a human coculture model, CLDN4-deficient astrocytes were unable to control lymphocyte segregation. In models of CNS inflammation and MS, mice with astrocyte-specific Cldn4 deletion displayed exacerbated leukocyte and humoral infiltration, neuropathology, motor disability, and mortality. These findings identify a second inducible barrier to CNS entry at the GL. This barrier may be therapeutically targetable in inflammatory CNS disease.
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Project description:A stent that was being implanted in the left circumflex artery, to treat an iatrogenic dissection, became dislodged at the ostial left circumflex artery on a previously deployed stent implanted for the treatment of a distal left main bifurcation stenosis. We describe here a novel technique to retrieve the device safely. (Level of Difficulty: Advanced.).
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Project description:Background/Objectives: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter. Methods: Consecutive patients undergoing ablation of CTI-dependent AFL using a power-controlled catheter or the novel temperature-controlled catheter were enrolled. Patients were followed up using a 7-day electrocardiogram after 3, 6, and 12 months. The primary endpoint was acute efficacy (procedural success, total RF, and procedure time). The secondary endpoint was the recurrence of typical AFL during follow-up. Results: In total, 38 patients undergoing temperature-controlled ablation were enrolled and compared to 283 patients undergoing power-controlled ablation. A bidirectional CTI block was achieved in 100% in the temperature-controlled group and 97.5% in the power-controlled group (p = 0.7). The total RF time (median: 192 sec (IQR 138-311) vs. 643 sec (IQR 386-1079), p < 0.001) and total procedure time (median: 45 min (IQR 34-57) vs. 52 min (IQR 39-70), p = 0.01) were shorter with temperature-controlled ablation. At the one-year follow-up, there was no difference in the recurrence of typical AFL between groups. Conclusions: Utilization of temperature-controlled ablation for typical AFL increased procedural efficiency with shorter RF and procedure times compared to power-controlled ablation. The recurrence rate of typical AFL after one year was low and did not differ amongst groups.
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Project description:Long-term cuffed hemodialysis catheters are being increasingly used in the management of patients with chronic kidney disease. These tunneled catheters are available in different types and characteristics. Patients undergo imaging, primarily chest radiographs to confirm the position of the catheter tip. It is essential to be aware of the normal imaging appearances of these catheters as they may simulate pathological appearance due to the shape of their tips. This knowledge will help avoid misdiagnosis and unnecessary medical interventions.
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