Coronary stent strut avulsion in aorto‐ostial in‐stent restenosis: Potential complication after cutting balloon angioplasty

Abstract

We report a case of stent strut avulsion by the cutting balloon during the withdrawal of the deflated balloon catheter in aorto-ostial in-stent restenosis, which was managed successfully by another stent. The proposed mechanisms and recommendations to avoid this rare complication are provided.

Case series of iatrogenic coronary stent avulsion: a rare complication with varied management strategies

“…In our patients, two stents were caught and avulsed by the guidewire, whereas a third was caught by a stent catheter. A number of other mechanisms of coronary stent avulsion have been reported including stents being caught on and avulsed by cutting balloons, 3 , 12 , 13 an aspiration catheter, 2 orbital atherectomy burr, a guide extension catheter, 4 another stent, 14 or a snare meant for retrieving another piece of equipment. 1 These cited case reports do not exclusively describe the avulsion of ‘freshly’ implanted stents since some of these stents were more than 6 months old.…”

“… 1 , 2 , 4 , 13 Where part of the avulsed stent remained within the coronary vasculature, one group successfully crushed the remaining part against the wall of the coronary artery with a high-pressure balloon and deployed another stent across it to establish definitive coronary patency. 3 One case reported surgical intervention as the bailout strategy of choice. 12 Finally, a case where the avulsed stent embolized into the brachial artery utilized a combination of percutaneous implantation of new stents in the coronary artery and a surgical extraction of the retracted stent from the brachial artery.…”

A novel technique for catheter engagement of protruding aorto‐ostial stent

“…Also, predilatation of the strut of the Cypher stent with a large‐sized balloon would have been required. Predilatation might have induced deformation and avulsion in the protruding segment , which would have increased the risk of stent embolism in the cerebral and peripheral circulations .…”

Noninvasive Evaluation of a Cutting Balloon Entrapped in a Left Main Coronary Artery Using Transesophageal Echocardiography

“…An estimated 1 million percutaneous coronary interventional procedures are performed annually in the United States 7 . In the recent years, the cutting balloon device has been increasingly employed in the revascularization of resistant atherosclerotic lesions, aorta‐ostial stenotic lesions, and in the setting of in‐stent restenosis 8 . The cutting balloon is a complex and intricate catheter device consisting of three to four longitudinal microblades mounted on the surface of the angioplasty balloon, and its use has been associated with inadvertent entrapment, extraction, and avulsion of portions of existing stents 9 …”