Successful Percutaneous Stentectomy a Decade After Coronary Stent Implantation

Percutaneous coronary stentectomy may be performed for in-stent restenosis involving a protruding coronary stent at an aorto-ostial location.

The key procedural steps are as follows: 1) advance an 8-F guiding catheter and a 6-F guide-extension catheter in a mother-daughter configuration, along with a goose-neck snare; 2) position the snare around the protruding segment of the stent; 3) advance the guide extension to secure the snare loop and apply traction; and 4) once resistance is overcome, withdraw all equipment en bloc and inspect to confirm retrieval of the stent within the snare.

Potential pitfalls include stent elongation without fracture, injury to the aorto-ostial region, embolization of stent fragments, and failure to successfully engage the protruding stent with the snare.

Protruding coronary stents can hinder revascularization. This case demonstrates that percutaneous snare-assisted stentectomy can be performed nearly a decade later to enable successful revascularization; however, potential complications must be carefully considered.