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Published on: May 14, 2013
A Challenging Case of Stent Dislodgement During Percutaneous Coronary Intervention Complicated by Peripheral
Frances Greathouse1, Parth V Desai2, Wajahat Humayun2
1Department of Internal Medicine, Loyola University Medical Center, Maywood, USA.
Insights
Coronary stent dislodgement during a transradial coronary angiogram led to embolization. The case highlights challenges in managing stent loss and retrieval complications.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- A 49-year-old male with end-stage renal disease and diabetes required cardiac risk stratification before kidney transplant.
- An elective transradial coronary angiogram was planned to assess coronary artery disease.
Observation:
- Severe lesions in the left circumflex artery (LCx) were identified.
- During stenting, the coronary stent dislodged into the left main coronary artery (LMCA).
- Initial retrieval using a balloon anchoring technique was successful, but the stent subsequently embolized to the right superior gluteal artery.
Findings:
- Successful retrieval of a dislodged coronary stent from the LMCA was achieved using a specialized technique.
- Accidental embolization of the stent to a peripheral artery occurred during the retrieval process.
- The patient remained asymptomatic with the peripherally embolized stent, obviating the need for further intervention.
Implications:
- This case underscores the potential complications associated with coronary stent dislodgement and retrieval.
- It emphasizes the importance of careful technique and awareness of risk factors for stent loss during interventional procedures.
- Management strategies for coronary stent embolization, even in peripheral locations, require careful consideration of risks and benefits.
Abstract:
We report a challenging case of stent dislodgement for a 49-year-old male with a history of end-stage renal disease and insulin-dependent diabetes undergoing an elective coronary angiogram for cardiac risk stratification before kidney transplant surgery. A diagnostic transradial coronary angiogram was performed showing two severe type A lesions to the proximal and distal left circumflex artery (LCx). While attempting to stent the proximal LCx, the stent dislodged to the left main coronary artery (LMCA). The stent was successfully retrieved from the LMCA via the transradial route using the small balloon anchoring technique. Unfortunately, while attempting to retrieve the stent-balloon assembly, the stent was accidentally stripped off the balloon embolizing to the right superior gluteal artery. Given the stable location, no attempt was made to retrieve the stent and the patient had no complications on follow-up. This case highlights the challenges in managing coronary stent loss including risk factors for stent dislodgement, methods to retrieve the stent, and the risk of stent embolization.
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