A case of repeated occlusion in the common iliac artery due to an unexpected stent deformation
Minoru Ihara1, Akihiko Ueno, Yasuhide Tsuda
1Department of Cardiology, Cardiovascular Center, Kawasaki Saiwai Hospital, 31-27 Ohmiya-cho, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan, akihara2002@yahoo.co.jp.
Insights
Repeated common iliac artery (CIA) occlusion occurred in a patient due to unusual stent deformation. External pressure from spinal issues and massage likely caused the repeated stent compression and occlusion.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Iliac artery stenting is a common procedure for treating peripheral artery disease.
- Stent deformation can lead to restenosis and treatment failure.
- Understanding causes of unexpected stent failure is crucial for improving patient outcomes.
Observation:
- A 74-year-old male patient experienced recurrent left common iliac artery (CIA) occlusion after balloon-expandable stenting.
- CT angiography revealed crescent-shaped deformation of both stents.
- The deformation was attributed to external compression from a hyperostotic lumbar vertebral body.
Findings:
- The patient's history of using a massage machine for back pain was noted.
- External pressure from spinal hyperostosis, potentially exacerbated by massage, was suspected as the cause of repeated stent compression and occlusion.
- This case highlights an unusual mechanism of stent failure due to external mechanical forces.
Implications:
- This case underscores the importance of considering external mechanical factors in stent failure.
- Further research into biomechanical interactions between spinal conditions, external devices, and vascular stents is warranted.
- Improved patient screening and device selection may be necessary in cases with risk factors for external compression.
Abstract:
We report a case experiencing repeated common iliac artery (CIA) occlusion due to an unexpected stent deformation. A 74-year-old man with intermittent claudication had undergone balloon-expandable stenting for the left CIA. Six years after his first stent implantation, his left CIA was totally occluded inside the stent. We performed revascularization for the left CIA and achieved sufficient balloon inflation and balloon-expandable stenting. Then, one and a half years later, his left CIA was re-occluded. CT angiography showed compression by the protruding hyperostotic lumbar vertebral body, such that both stents had become deformed into a crescent shape. We were told that he had been using a powerful massage machine to stretch and relieve his spondylotic back pain. We suspected that the external pressure of the hyperostotic spondylosis and massage might have caused the CIA compression and repeated crush of the stents.
