Complex Inferior Vena Cava Filter Retrievals: Success Rate and Predictors of Adverse Events at a Large Specialized Referral Center.

BACKGROUND. Specialized inferior vena cava (IVC) filter referral centers can achieve improved retrieval outcomes, potentially facilitating complex retrievals after long filter dwell times. OBJECTIVE. The purpose of this study was to determine the success rate of complex IVC filter retrievals at a large specialized IVC filter referral center and to identify predictors of adverse events during complex retrievals. METHODS. This retrospective study included patients who underwent complex IVC filter retrieval from March 2014 to June 2018 at a large regional health system with specialized complex retrieval referral centers and interventional radiologists with expertise in such procedures. Complex retrievals methods included a range of loop snare, coaxial sheath, forceps, and snare techniques. Data were collected from the electronic medical record. The success rate of complex retrieval was determined. Factors associated with adverse events during retrieval procedures were explored. RESULTS. The study included 125 patients (51 women, 74 men; mean age, 60 years). The mean filter dwell time at retrieval was 47.5 months (median, 21.8 months). The complex retrieval success rate was 99.2% on the first attempt and 100.0% overall. A total of 11.2% (14/125) of patients experienced an adverse event during retrieval, including 10.4% (13/125) with minor and 0.8% (1/125) with major events. Prolonged dwell time was the only indication for complex retrieval that was significantly associated with adverse events (adverse event rate, 16.7% for patients with this indication vs 5.1% for patients without this indication; p = .04). In multiple regression analysis, the only significant independent predictor of adverse events was a filter dwell time of 5 years or longer (odds ratio, 6.98 [95% CI, 1.64-29.81]; p = .009). CONCLUSION. In a specialized referral system with expertise in complex retrieval methods, high retrieval success rates can be achieved in patients who have filters with long dwell times. Nonetheless, longer dwell times are associated with adverse events during retrieval procedures. CLINICAL IMPACT. The observations support performing early filter retrieval and referring patients who have filters with prolonged dwell times to specialized centers.

AngioJet thrombectomy and stenting for reperfusion in acute MI complicated with cardiogenic shock.

AngioJet thrombectomy (AJ) has been shown to be safe and effective in treatment of acute myocardial infarction (AMI). However, use of AJ has not been studied extensively in AMI with cardiogenic shock (CS). Clinical outcomes in 19 patients with CS and treated with AJ were retrospectively analyzed. Immediate stenting was also performed. Procedure success (final diameter stenosis < 50% and TIMI flow > or = 2) was achieved in 95%, with final TIMI 3 flow in 89%. Clinical success (procedure success without major in-hospital cardiac events) was achieved in 68%. There were five in-hospital deaths and no patients experienced stroke or required emergent bypass surgery. At 30-day follow-up, there were no additional deaths or stroke, and two patients had undergone target vessel revascularization. AJ is relatively safe and effective in the setting of AMI complicated with CS, allowing for immediate definitive treatment. This strategy may offer improved mortality in these high-risk patients.