Thromboembolism associated with pigtail catheters

Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part I--Pathophysiological and pharmacological features

Thromboembolic and ischemic complications frequently occur during and after endovascular procedures, because of associated arterial injury and the thrombogenic characteristics of arterial catheters, contrast agents, and implanted devices such as coils and stents. Platelet adhesion, activation, and aggregation occurring at the site of arterial injury are mediated by local factors, including thromboxane A2 (inhibited by aspirin) and adenosine diphosphate (inhibited by ticlopidine and clopidogrel). Concomitantly, thrombin is formed by serial activation of clotting factors via contact with subendothelial tissue factor. Thrombin cleaves fibrinogen into fibrin. Thrombin activation is indirectly blocked by heparin and its analogs. However, after thrombin is clot-bound (with fibrin), it is relatively protected from heparin and is effectively blocked only by direct thrombin inhibitors (hirudin and its analogs). The final common pathway in clot formation is the binding of fibrinogen to platelets via platelet glycoprotein IIb/IIIa receptors, which is inhibited by antibodies to platelet IIb/IIIa receptors. New treatment modalities, such as the use of direct thrombin inhibitors and antibodies to platelet glycoprotein IIb/IIIa, seem to be more effective for prophylaxis and treatment than conventional anticoagulation and antiplatelet therapies.

Relief of pressure damping during coronary angioplasty: a device for creating side holes in PTCA guiding catheters

Percutaneous coronary angioplasty guiding catheters occasionally wedge in the coronary orifice and obstruct blood flow, making completion of the balloon dilatation difficult. Side holes may be made in the catheter, but when created free-hand may not be ideal. This report describes a device for creating side holes of small size, with uniform shape, and without rough edges. The disadvantages of dye extravasation and loss of strength in the catheter are minimized.

Comparison of the performance of pigtail catheters with different number of sideholes

The standard 12 sidehole pigtail catheter is compared with pigtail catheters with 6, 8, and 10 sideholes in 40 patient studies. The catheter with fewer sideholes performed as well as the standard catheter with respect to the quality of left ventricular opacification, lack of catheter recoil during angiography, and absence of complications. An in vitro study confirmed that better flushing of the terminal segment beyond the sideholes is achieved with the 6 sidehole catheter compared to the 12 sidehole catheter. It is anticipated that this feature will decrease the risk of thromboembolism associated with the use of the pigtail catheter.