Coronary perforation during insertion of a long stent in a severely calcified lesion

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Engineering

Background:

• Rotational atherectomy is used to treat calcified coronary lesions.
• Stent implantation follows atherectomy to restore vessel patency.
• Complex lesion morphology presents challenges in stent delivery.

Observation:

• A 48-mm stent was deployed in a calcified coronary lesion post-rotational atherectomy.
• Stent stacking and S-shaped flection occurred during insertion.
• Longitudinal coronary perforation resulted, without stent inflation.

Findings:

• The stent's significant length (48 mm) and inherent flexibility contributed to its deformation.
• Mechanical forces during insertion in a calcified, treated vessel led to adverse stent behavior.
• The observed flection and stacking occurred prior to full stent deployment or inflation.

Implications:

• Stent design, particularly length and flexibility, is critical for safe delivery in complex coronary anatomy.
• Techniques to mitigate stent deformation during delivery in calcified lesions may be needed.
• This case highlights potential risks associated with specific stent characteristics in challenging interventional scenarios.