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Published on: May 14, 2013
Stent luxation: Possible complication of subadventitial stenting in coronary chronic total occlusion
Rustem Dautov1, Can M Nguyen1, Stéphane Rinfret1
1Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Quebec City, Canada.
Insights
Subadventitial stenting in chronic total occlusion percutaneous coronary intervention is effective. However, overlapping stents can dislocate, leading to late stent thrombosis, a complication to be avoided.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Subadventitial stenting is a successful strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Long-term outcomes of subadventitial stenting are comparable to traditional intraluminal stenting.
- The unique histological and physiological characteristics of the subadventitial space necessitate specific considerations.
Observation:
- A novel complication associated with subadventitial stenting has been identified.
- Overlapping stents deployed within the subadventitial space can dislocate.
- This dislocation can lead to late non-occlusive stent thrombosis.
Findings:
- This is the first reported instance of stent dislocation and subsequent thrombosis in the subadventitial space.
- Analysis suggests potential reasons for stent overlap and dislocation in this anatomical plane.
- Strategies for avoiding this complication during CTO PCI are proposed.
Implications:
- Understanding and preventing stent dislocation is crucial for patient safety in subadventitial stenting.
- This finding may influence stent selection and deployment techniques in complex PCI.
- Further research into the biomechanics of stenting in the subadventitial space is warranted.
Abstract:
The entry to the subadventitial space is not a mode of failure, but the road to success in many chronic total occlusion (CTO) percutaneous coronary intervention (PCI) cases. Long-term clinical outcomes of subadventitial stenting are favorable and similar to intraluminal stenting. However, the subadventitial space histology and physiology remains different to the coronary true intraluminal space. We report a complication specific to stenting of the subadventitial space, where overlapping stents dislocated from one another, which resulted in late non-occlusive stent thrombosis. We describe, for the first time in the literature, this complication, possible reasons behind, and the ways to avoid this potentially major mischief. © 2016 Wiley Periodicals, Inc.
