Lots of interesting abstracts and cases were submitted for TCTAP 2026. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge!
CASE20251113_002
A Story of Unfriendly Stents
By Donluck Poonkasem
Presenter
Donluck Poonkasem
Authors
Donluck Poonkasem1
Affiliation
Vibharam, Thailand1
View Study Report
CASE20251113_002
Coronary - Complication Management
A Story of Unfriendly Stents
Donluck Poonkasem1
Vibharam, Thailand1
Clinical Information
Relevant Clinical History and Physical Exam
A 60-year-old woman with Type-2 diabetes and hypertension presented with chest pain 5 hoursShe had sudden cardiac arrest at emergency department.After ROSC, she was sent to Cath lab immediately due to suspected of anterior wall STEMI.
Relevant Test Results Prior to Catheterization
ECG showed STE in V1-V4 with new RBBB
Relevant Catheterization Findings
Angiogram showed total thrombus occlusion in LAD, 90% stenosis in LCX and CTO mid RCA
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t2 (1).mp4 t10.mp4Interventional Management
Procedural Step
After successfully PCI to LAD with 1 DES from ostial to mid LAD, patient was sent to admit in CCU ward with IABP in order to secure hemodynamics.Her hemodynamics and clinical symptoms were improved, but she cannot be withdrawn from IABP.Thus, we plan to stage PCI to RCA and LCX in this admission.CTO lesion at RCA was fixed with PCI smoothly. We deployed two stents along vessel after overcoming CTO. The final vessel (LCX) was also done with PCI too. Pre-dilation with 2.0 balloon was done to distal LCX. But we cannot deliver stents to lesion. The stent was stuck with the previous stent in LAD. Then, we tried to push it forward forcefully but it did not move even a little. So, we tried to pullback and then, the balloon was dislodged from the stent and also loss the wire due to attempting of small balloon cannulation. We tried to use many ways to catch the stent back but we failed. Finally, we use micro snare to grab the stent. After we strongly pulled it out, unfotunately, the snare was torn and stuck with the proximal stent. Thus, we used the bigger snare to retrieve both micro snare and stents. Not only LCX stent but also LAD stent was pulled it out from the vessel which created long dissection in LM to LAD and LCX.Then, we had to start PCI to LCX first and then LAD, respectively.Finally, PCI was done to both LM-LAD and LCX successfully with 3 DES by POT-kiss-POT strategy.
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U14___.mov U18.mov U26.movCase Summary
Post dilation to proximal segment of stent could make it elongated. Thus, you have to be carefully delivered the stent pass through the protruded stent.Snare can help you to retrieve dislodged stent but you should be careful when pull it back forcefully. Trapping the shaft-snare with small balloon could make your system stronger.