Crumpled and Dislodged Stent: Rotational Atherectomy Is the Final Choice

The objective of this paper is to show how to achieve a lumen through a dislodged deformed stent by rotational atherectomy and crush it by deploying another stent.

The key steps are as follows: 1) Delivery of a stent through a proximally stented right coronary artery resulted in dislodgement of the stent; an attempt to retrieve it by "small balloon" technique resulted in the lifting up of the previously implanted stent. 2) With an intention to crush the deformed stent, even the smallest balloon failed to cross the crumpled stent. 3) Rotational atherectomy with a 1.5-mm burr was unsuccessful; downsizing the burr to 1.25 mm was successful. 4) Finally, the crumpled stent was successfully crushed with a noncompliant balloon followed by a stent.

Vessel injury because of wire bias and burr entrapment remain the 2 major pitfalls of this technique.

A dislodged stent that cannot be retrieved or crushed should be ablated with rotational atherectomy. Starting with the smallest burr and gradual upsizing increases procedural success.