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Two stents' dislodgement in the left main coronary artery: a case report
Salim Arous1, Hatim Zahidi2, Mohamed El Ghali Benouna2
1Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco. Arous.salim@hotmail.fr.
Insights
Stent dislodgement, a rare but serious complication during percutaneous coronary intervention, can be managed by stent retrieval or crushing. This case highlights a successful balloon expansion technique for lost stents in the left main artery.
Area of Science:
- Interventional Cardiology
- Cardiovascular Devices
Background:
- Stent dislodgement is a critical complication in percutaneous coronary intervention, potentially leading to severe outcomes like coronary artery embolization and stent thrombosis.
- Risk factors include tortuous, calcified, and previously stented vessels, though incidence has decreased to <1% with modern techniques and drug-eluting stents.
Observation:
- A case report details a 64-year-old man experiencing loss of two stents during left main coronary artery intervention.
- The complication occurred despite advancements in lesion preparation and stenting technology.
Findings:
- Successful management of lost stents was achieved by inflating a balloon within the dislodged stent, effectively expanding it in place.
- Device characteristics may contribute to stent loss, but the exact mechanisms require further investigation.
Implications:
- Stent retrieval is the primary treatment for dislodged stents; crushing is an alternative if retrieval fails.
- This case demonstrates an alternative management strategy for lost stents, particularly in complex anatomies like the left main artery.
Background:
Stent dislodgement is a life-threatening complication that can result in coronary artery embolization, stent thrombosis, acute myocardial infarction, and even death. Severely angulated, heavily calcified, and previously stented coronary arteries are associated risk factors. With the development of different lesion preparation techniques and the drug eluting stent era, the reported incidence of stent dislodgement has decreased to < 1% in the last few years.
Case Presentation:
We report a case of a 64-year-old Moroccan man complicated during percutaneous intervention in the left main artery by the loss of two stents. This complication was successfully managed by passing the stent's balloon into the stent and then fully expanding it. In our case, the device's characteristics were involved and could play a role in such complications, but it is still not well understood.
Conclusions:
The main treatment option is stent retrieval with different available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.
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