Bailout technique to remove a distal protection device (‘Filtrap’) when the retrieval and delivery catheters could not pass through the deployed stent

Although aspiration thrombectomy might be considered only in patients with ST-segment elevation myocardial infarction (STEMI) according to the European Society of Cardiology guidelines, small studies showed that aspiration thrombectomy and/or distal embolic protection might be effective to prevent slow flow/no flow during percutaneous coronary intervention (PCI) in non ST-segment elevation myocardial infarction (NSTEMI) patients with thrombus or attenuated plaque according to Japanese Circulation Society (JCS) Guidelines for management of acute coronary syndrome without persistent ST-segment elevation [1–6]. Distal embolic protection should be considered in NSTEMI patients with thrombus or attenuated plaque in Japan, which is supported by these Guidelines. However, data to support distal protection in STEMI/NSTEMI are scarce, and this technique is not broadly adopted elsewhere [1, 2]. Either occlusive or filter-based systems can catch thrombus and/or debris that may damage distal tissue. Their insert packages recommend aspiration in the culprit lesion before removal to prevent distal embolism on removal. A filter-based device (Filtrap, Nipro, Japan) was designed to capture debris while preserving coronary blood flow and making the procedure simple and smooth [5, 6]. In this article, we present a bailout technique to remove the Filtrap device when the retrieval and delivery catheters could not pass through the deployed stent.