Embolized Stent in the Coronary Circulation “Without Riding the Wire” and its Novel Management Strategy
- Volume 21 - Issue 10 - October, 2009
- Posted on: 10/13/09
- 0 Comments
- 2366 reads
From the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted February 24, 2009, provisional acceptance given May 11, 209 and final version accepted May 28, 2009.
Address for correspondence: Prof. Afzalur Rahman, MD, PhD, Head of the Department, Department of Cardiology, Sir Salimullah Medical College & Mitford Hospital, Dhaka 1000, Bangladesh. E-mail: email@example.com
ABSTRACT: We report a unique technique for retrieval of a coronary stent, embolized during percutaneous coronary intervention (PCI), using conventional angioplasty wires and angioplasty balloon catheters. In this case, the stent embolized into the distal left main and proximal left circumflex arteries. As the guide catheter and percutaneous coronary angioplasty (PTCA) wire were withdrawn from the coronary arteries, the stent was freely floating in the coronary circulation “without riding the wire”. It was managed by re-entry of the Intermediate PTCA wire through the stent with the help of an over-the-wire balloon and was successfully deployed across the lesion. Stent embolization, although a very rare event, may lead to devastating consequences. This technique has been demonstrated for the first time and employs readily available tools that are familiar to all operators.
J INVASIVE CARDIOL 2009;21:E201–E203
Stents are currently utilized in the majority of percutaneous coronary interventions (PCIs) because they improve angiographic outcomes and decrease rates of angiographic restenosis and repeat revascularization. A rare but potentially serious and challenging complication of coronary stenting is stent loss, which can result in systemic or coronary embolization, emergency coronary artery bypass graft surgery or even death. Manual mounting of stents (which used to be practiced in past) was associated with a significantly higher risk of stent embolization. Besides this, inadequate predilatation, calcified lesions and tortuous lesions increase the chances of stent embolization. Different methods for nonsurgical stent retrieval have been suggested.1–3 Snare devices are commonly used to retrieve the stent. Here we report a case where the stent embolized “without riding the wire” was managed by using a conventional percutaneous transluminal coronary angioplasty (PTCA) wire and angioplasty balloon catheter.