Korean Circ J.  2016 Nov;46(6):862-865. 10.4070/kcj.2016.46.6.862.

Extraction of a Fully Deployed Coronary Stent during Retrieval of Another Dislodged Stent

• Hwang J
• Chun KJ
• Lee DS
• Lee SY
• Chon MK
• Lee SH
• Hwang KW
• Kim JH

• KMID: 2355464
• DOI: http://doi.org/10.4070/kcj.2016.46.6.862

Abstract

Coronary stent dislodgement is a rare and serious complication of percutaneous coronary intervention and is associated with major adverse cardiac events. Successful retrieval of the stent is recommended in this situation because it is important for the prognosis. Recently, a patient was referred to our hospital with a dislodged coronary stent. When attempting to percutaneously extract the dislodged stent, a challenging situation was encountered, as the stent was entrapped and tightly entangled with another fully deployed coronary stent. Extraction of a fully deployed stent is generally prohibited as it may result in severe complications. Nevertheless, we extracted both the dislodged stent and the fully deployed stent, as a last resort. Herein, we report about this case. Our case highlights if the operator had a thorough understanding of the surrounding circumstances regarding the fully deployed coronary stent, successful extraction of the fully deployed coronary stent without any complications could be possible.

Keyword

Percutaneous coronary intervention; Stent; Complication

MeSH Terms

Health Resorts
Humans
Percutaneous Coronary Intervention
Prognosis
Stents*

Figure

• 

  Fig. 1 Baseline coronary angiogram. (A) Left anterior oblique cranial view shows a diffused long lesion with a very small right coronary artery (RCA). (B) Two stents were inserted at the proximal and mid segments of the RCA.

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  Fig. 2 Fluoroscopic images of the procedure. (A) The operator at the local hospital failed to deliver a second stent into the distal RCA. While attempting to retract the undeployed stent (white arrow) into the guiding catheter, the stent was entrapped by the fully deployed stent in the proximal RCA (white arrow head) and totally detached from the stent balloon. (B) We were able to capture the middle portion of the undeployed dislodged stent (white arrow) using a multi-snare catheter. (C) Under manual retraction, the proximal RCA deployed stent (white arrow head) was elongated but not detached from the undeployed dislodged stent (white arrow). (D) Under continuous retraction, the captured undeployed stent (white arrow) was bent in half and successfully retrieved into the guiding catheter. (G) Finally, both the maximally elongated proximal RCA stent (white arrow head) and the bent, partially dislodged stent (white arrow) were successfully retrieved into the guiding catheter. (H) Final CAG of the RCA showed excellent results with TIMI grade 3 distal flow. RCA: right coronary artery, CAG: coronary angiogram, TIMI: thrombolysis in myocardial infarction.

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  Fig. 3 Retrieved stents. The Xience 2.75x38 mm stent was once fully deployed and elongated into the proximal RCA. The Promus 2.5x38 mm stent was undeployed and bent in half upon retrieval using a multi-snare catheter. RCA: right coronary artery.

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  Fig. 4 Results of the in vitro maximal stretching test of two different types of stents. (A) is the stent with 3 connectors (Xience Xpedition, Abbott Vascular, Santa Clara, CA, USA) that was not fractured but rather elongated. (B) is the stent with 2 connectors (Promus Premier, Boston Scientific, MN, USA ) that was fractured into four segments.

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