PMC8084362_01
A. Angiography demonstrates detachment of the soft distal tip of the guide extension catheter (GEC) filled with contrast from guiding catheter to the left ventricle; B. Echocardiography confirmed placement of the GEC inside the left ventricle and left atrium; C. Angiographic imaging visualized placement of the distal radiopaque tip of GEC in the left atrium; D. Successful percutaneous retrieval of the GEC was performed via the trans-septal approach; E. The GEC was detracted inside the sheath; F. Final echocardiography confirmed successful retrieval of the GEC.
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An unexpected detachment of the soft distal tip of the GEC (at the connection of the rapid exchange section and pushing rod) and its dislocation from the guiding catheter to the left ventricle (LV) was observed during final angiography (Fig. 1A). Echocardiography imaging confirmed localization of the GEC in the LV and left atrium (LA) (Fig. 1B). Angiographic imaging visualized the presence of the radiopaque GEC tip in the LA (Fig. 1C). An 8.5 deflectable Agilis sheath was introduced into the LA after a trans-septal puncture and retrieval of the dislodged GEC was performed using a gooseneck snare loop (Fig. 1D). The GEC was successfully removed from the LA (Fig. 1E), which was confirmed in the final echocardiography (Fig. 1F).