In Reply to: Re: Case 0300_10 -- Circumferential Tear of A Balloon Catheter with Subsequent Loss of the Fragment within the Iliac Artery ? A Unique Indication for Iliac Stenting posted by Grant Price on March 09, 2000 at 14:59:04:
I would commend the authors on a nice job managing a difficult situation. I do not believe that primary stent placement would have prevented the protruding ends from the existing Wallstents from rupturing the balloon. Ipsilateral access would have prevented need to fenestrate aortic end of Wallstent (usually goes fine but may turn into disaster if something gets stuck - like ruptured balloon).
Once balloon had ruptured (but before it was sheared off) an ipsilateral access might have been used to snare GW and advance an ipsilateral sheath over the distal end of balloon which could not be collapsed due to rupture.
I have seen several circumferential tears with shearing off of balloon fragments upon catheter removal(all in dialysis grafts). In all of these cases, the fragment remained on guidewire. Snare is advanced coaxially around guidewire or along guidwire. Fragment or guidewire beyond fragment can be snared for retrieval.
Assuming these options were exhausted, I think stenting it out of the way was reasonable. Sure there is modest risk of infection but I would prefer this over operative intervention. I believe an embolectomy from CFA approach and fluoroscopic guidance could retrieve fragment but would advocate this only after other efforts are exhausted. I assume patient is a poor AFB operative candidate or we should not have started down this pathway.
I too am reluctant to place stents of different metallic compositions together. I am told that the resultant small ionic charges which are produced may prematurely degrade the metal. This is theoretical and I have not seen or heard of a clinical case.