JACC. Case reports · 2026
Pedal Pull-Through Rail and Wingman-Assisted Coaxial Push for Entrapped Device Retrieval in Calcified Tibial Arteries.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Miyazaki Akane, Yoshinaga Masataka, Murata Keisuke, Araki Toru, Matsuo Kouki, Ito Takehiro, Sobue Yoshihiro, Muramatsu Takashi, Fujiwara Wakaya, Watanabe Eiichi
Аннотация
OBJECTIVE: To describe a bailout technique for retrieving an entrapped, fractured endovascular device fragment in severely calcified below-the-knee arteries when conventional snare retrieval is not feasible.
KEY STEPS: 1) Immediately stop manipulation and maintain the position of the antegrade guidewire holding the fragment (the "Golden Rule"); 2) obtain retrograde access; 3) advance a snare from the retrograde sheath to capture and externalize the existing antegrade guidewire, creating a pull-through rail without wire exchange; 4) advance a Wingman catheter antegradely over the rail; and 5) apply short, coaxial pushes to dislodge the fragment and retrieve it via the retrograde sheath.
POTENTIAL PITFALLS: Retrograde distal puncture and sheath insertion are difficult without a sufficient vascular diameter in either the dorsal foot artery or posterior tibial artery. Avoid loss of the guidewire during procedure and vessel injury.
TAKE-HOME MESSAGE: Never surrender the workhorse wire holding the fragment; converting it into a pull-through rail enables safe coaxial dislodgement.
KEY STEPS: 1) Immediately stop manipulation and maintain the position of the antegrade guidewire holding the fragment (the "Golden Rule"); 2) obtain retrograde access; 3) advance a snare from the retrograde sheath to capture and externalize the existing antegrade guidewire, creating a pull-through rail without wire exchange; 4) advance a Wingman catheter antegradely over the rail; and 5) apply short, coaxial pushes to dislodge the fragment and retrieve it via the retrograde sheath.
POTENTIAL PITFALLS: Retrograde distal puncture and sheath insertion are difficult without a sufficient vascular diameter in either the dorsal foot artery or posterior tibial artery. Avoid loss of the guidewire during procedure and vessel injury.
TAKE-HOME MESSAGE: Never surrender the workhorse wire holding the fragment; converting it into a pull-through rail enables safe coaxial dislodgement.