Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous
Sonja Salinger-Martinović1, Sinisa Stojković, Milan Pavlović
1Clinic for Cardiovascular Diseases, Clinical Centre, Nis, Serbia. sonja.salinger@gmail.com
Insights
Stent dislodgement during percutaneous coronary intervention is rare but serious. A dislodged stent in the left main coronary artery was successfully retrieved using a balloon catheter, preventing a life-threatening complication.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Stent dislodgement before deployment is a rare but severe complication in percutaneous coronary intervention.
- Newer generation coronary stents are associated with this risk, necessitating careful procedural management.
Observation:
- A case of stent dislodgement into the left main coronary artery (LMCA) during primary intervention for an acute myocardial infarction is presented.
- An unexpanded bare-metal stent was lodged in the LMCA, likely due to guiding catheter manipulation, but remained on the guidewire.
Findings:
- Successful retrieval of the dislodged stent was achieved using a low-profile balloon catheter passed through the stent.
- The retrieved stent and delivery system were withdrawn, allowing for subsequent successful stenting of the target lesion.
Implications:
- This case highlights a potentially life-threatening complication during acute myocardial infarction intervention.
- Careful handling of guiding catheters and delivery systems is crucial to prevent stent dislodgement in the LMCA.
Introduction:
Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication.
Case Outline:
We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion.
Conclusion:
Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.
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