Percutaneous Coronary Stentectomy: Redefining Stent Failure Management in the Modern Era

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery
• Medical Device Retrieval

Background:

• Deployed coronary stents can cause complications like malapposition or protrusion, leading to restenosis or thrombosis.
• Interference with structural heart interventions necessitates addressing deployed stent issues.
• Intentional percutaneous coronary stent retrieval has transitioned from salvage to a structured strategy.

Purpose of the Study:

• To review the literature and present case studies on intentional percutaneous coronary stent retrieval (stentectomy).
• To evaluate the feasibility and techniques of coronary stent retrieval in various clinical settings.
• To highlight the role of intravascular imaging and complementary techniques in stentectomy.

Main Methods:

• Narrative literature review on intentional percutaneous coronary stent retrieval.
• Analysis of five illustrative cases from three academic centers (acute, subacute, late retrieval).
• Predominant use of snare-based retrieval via guide extension catheters; assessment of stent connector impact.

Main Results:

• Stentectomy proved feasible in acute and late settings, with snare-based retrieval being the primary method.
• Stents with fewer inter-ring connectors facilitated more predictable extraction.
• Intravascular ultrasound was crucial for planning, confirmation, and post-procedure management; drug-coated balloons enabled metal-free revascularization.

Conclusions:

• Percutaneous coronary stentectomy is a feasible strategy for selected patients with deployed stent complications.
• Intravascular imaging is central to planning and assessing stentectomy procedures.
• Stentectomy, with appropriate technique and Heart Team evaluation, can resolve stent issues, restore access, and allow metal-free revascularization.