Repeat stent implementation for recanalization of the proximal right coronary artery: a case report

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Stent malpositioning in a false lumen is a recognized complication following percutaneous coronary intervention (PCI).
• This complication is particularly noted in the treatment of acute myocardial infarction (AMI).
• Stent occlusion in a false lumen can lead to recurrent symptoms and treatment failure.

Observation:

• A case is presented of a 40-year-old male with recurrent angina 6 months post-PCI for acute inferior wall myocardial infarction.
• Coronary angiography and intravascular ultrasound (IVUS) revealed the previously implanted stent was located in a false lumen of the right coronary artery.
• The patient experienced symptomatic angina due to the malpositioned stent.

Findings:

• Intravascular ultrasound (IVUS) was crucial for accurately differentiating the true lumen from the false lumen.
• A novel technique involved using IVUS to guide re-entry into the true lumen.
• A second stent was successfully deployed in the true lumen, crushing the malpositioned stent into the false lumen.

Implications:

• This case highlights a successful strategy for managing stent malposition in a coronary artery false lumen.
• Intravascular ultrasound (IVUS) is demonstrated as an indispensable tool for diagnosis and procedural guidance in such complex cases.
• Crushing a malpositioned stent with a new stent offers a viable solution for recanalization and symptom relief.