J Cardiovasc Interv.  2022 Oct;1(4):180-185. 10.54912/jci.2022.0012.

Triple or More Multiple Snare Techniques to Retrieve an Embolized Figulla^® Septal Occluder

• Koo M
• Ha KS

• KMID: 2561257
• DOI: http://doi.org/10.54912/jci.2022.0012

Abstract

Transcatheter device closure of atrial septal defect (ASD) is a safe and feasible procedure with many advantages. Nevertheless, several complications such as device embolization and erosion can occur. A 59-year-old man with moderate-sized ASD (16–22 mm), underwent transcatheter device closure using the Figulla ® Flex II septal occluder (FSO). The FSO embolized while it was unfolded in the right atrium (RA) to remove the microbubbles buried in the device (test deployment). The central bioptome in the delivery system of the FSO did not grasp tightly the hub-pin in RA during test retrieval, and the FSO device was slipped out and embolized into the main pulmonary artery. The single- and doublesnare techniques tried to retrieve the embolized FSO device many times. However, they were not strong enough to pull the device and could not grasp the hub-pin at the RA. The triple-snare technique was introduced for additional grasping and traction force. The small hub-pin of the FSO was then successfully caught and pulled out with triple snares into the delivery sheath. Additionally, it is possible to use three- or multiple-snare techniques in more complicated cases of embolized devices. The multiple-snare technique provides a balanced traction force by multiple directional pulling. Therefore, the three or multiple-snare technique can be more effective in retrieving embolized ASD devices with a small round hubpin, compared to the single- or double-snare techniques.

Keyword

Atrial septal defect; Catheterization closure devices; Device removal