GALILEO CENTERING CATHETER III

Description of Event or Problem

A CENTERING CATHETER WAS USED FOR A BRACHYTHERAPY PROCEDURE IN THE PROXIMAL LAD. THE PT PRESENTED TO THE CATH LAB WITH MULTIPLE CO-MORBIDITIES AND DID NOT TOLERATE ANY PART OF THE PROCEDURE WELL. PREDILATATION OF THE LESION WAS PERFORMED, AS WELL AS AN ATTEMPT TO TREAT THE LESION WITH ANOTHER CENTERING CATHETER. POSITIONING AND DELIVERY OF THERAPY WAS PERFORMED WITHOUT COMPLICATIONS WITH THE CATHETER AND THE DEVICE REMOVED. ANOTHER LESION WAS IDENTIFIED 5-10 MM PROXIMAL TO THE TREATMENT SITE AT THE LAD TAKEOFF FROM THE LEFT MAIN. IT WAS TREATED WITH A BALLOON AND A STENT. THE CIRCUMFLEX ARTERY THEN ACUTELY SHUT DOWN. MULTIPLE ATTEMPTS WERE MADE TO REOPEN THE VESSEL WITHOUT SUCCESS AND THE PT DIED. THE PHYSICIAN BELIEVED THE CENTERING CATHETER PLAYED A PART IN THE CLOSURE OF THE VESSEL.