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Expanded Stent Migration and Renal Artery Embolization During Aorto-Ostial Left Main Percutaneous Coronary
Hendrianus1, Sang Yeub Lee2, Jinhwan Jo2
1Division of Cardiology, Natuna General Hospital, Natuna, Indonesia; Division of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
Insights
A fully expanded coronary stent dislodged during percutaneous coronary intervention and embolized systemically. In situ expansion of the dislodged stent at the embolization site was a safe management option when retrieval was high risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- Stent dislodgement and systemic embolization are rare but severe complications during percutaneous coronary intervention (PCI).
- Aorto-ostial left main artery stenosis is a critical condition requiring precise PCI techniques.
Background:
Stent dislodgement with systemic embolization is a rare but serious complication of percutaneous coronary intervention.
Case Summary:
During intravascular ultrasound-guided percutaneous coronary intervention for aorto-ostial left main artery stenosis, a fully expanded 4.0-mm drug-eluting stent dislodged upon balloon withdrawal. Angiography showed the stent partially floating in the aortic root, with its distal struts still anchored at the ostium, before its complete embolization. After securing the left main artery with a second stent, the dislodged stent was identified following systemic embolization to the left renal artery. Given the high risk of retrieval, it was managed in situ with balloon expansion to achieve full apposition against the vessel wall.
Discussion:
This report describes the rare event of systemic embolization of a fully expanded stent. Our experience indicates that in situ expansion may represent a practical alternative when retrieval poses significant hazards, offering a potential pathway to stabilize the complication.
Take-Home Messages:
Fully expanded coronary stents can in rare cases dislodge and embolize systemically. When retrieval is high risk, intentional in situ deployment at the embolization site provides a safe and definitive management option.
