Emergency intravascular ultrasound to locate a stent during primary angioplasty

A 62-year-old man underwent primary PTCA with bail-out stent placement for an acute anterior wall myocardial infarction. After initial deployment of one half of a Palmaz-Schatz stent, the stent could not be visualized fluoroscopically. Emergency intravascular ultrasound (IVUS) showed the stent to be located proximal to the intended site of deployment. This finding helped determine balloon positioning for subsequent high-pressure inflations and also led to deployment of another half stent in the correct site. This case demonstrates that availability of and familiarity with IVUS can benefit interventional cardiologists and their patients in unexpected circumstances.