Embolised Stent Into the Circumflex Coronary Artery During Percutaneous Coronary Intervention

Abstract

SUMMARYDislodgement and embolisation of the new generation of coronary stents before deployment are rare. If it is impossible to withdraw the embolised stent from the coronary artery, the stent may be crushed into the side wall of the coronary artery with a balloon over a wire passed alongside the embolised stent. (Int Heart J 2006; 47:125-129) Key words: Embolised stent, Balloon angioplasty, Coronary artery disease THE advent of stents and their increasingly widespread use has undoubtedly resulted in a huge improvement in intravascular intervention, but at the same time it has brought to the practice of angioplasty a plethora of various complications. It is worth considering these under a separate heading and in some detail since the use of stents seems set to increase. Stent dislodgement and embolisation are serious complications in coronary intervention. They were not rare when using first generation stents.1-3) Most new interventional cardiologists have not commonly encountered these complications because the new generation of stents are often not attached to a balloon. CASE REPORTA 53 year-old man was admitted for a postmyocardial infarction examination. Ten days earlier, he had suffered an inferolateral myocardial infarction. STelevation, T-wave inversion, and pathological Q waves in leads II, III, aVF, and V5-6 were present. He had no complaints and was a chronic cigarette smoker. The pulse rate was 85 beats/min and the arterial blood pressure was 110/85 mmHg. Examination of his organ systems revealed all were normal. An echocardiographic examination showed a hypokinetic inferior wall. The left anterior descending and right coronary arteries were normal on coronary angiography.From the

Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention

“…The dislodging may occur at the guide tip when traversing the coronary artery proximal to the lesion, or in the lesion itself. If the guide choice and stability are not proper, the guide will be displaced from the coronary ostium as the stent exits the guide and meets resistance in the coronary artery [7]. The stent cannot be pushed on because there is no backup.…”

“…The most important means of avoiding this complication is to take care with the manipulations as the stent exits or re-enters the guide. Unnoticed proximal coronary lesions or calcification can cause stent displacement during the advancement of the delivery system [7,8].…”

Acute Stent Loss and Its Retrieval of a Long, Tapering Morph Stent in a Tortuous, Calcified Lesion

“…Implantation of stent has significantly reduced restenosis and the need for repeat intervention after percutaneous coronary intervention (PCI). Stent dislodgement is an uncommon occurrence in modern PCI and is often associated with significant morbidity in form of coronary thrombosis and subsequent myocardial infarction, sudden cardiac death, and acute limb occlusion [ 1 - 4 ]. In the past, manual crimping of stents which is rarely practiced now was associated with a significantly increased risk of stent dislodgement and embolization.…”

Peripheral embolisation and retrieval of an everolimus-eluting stent during intervention in a tortuous right coronary artery

“…Stent dislodgement and its embolisation is an uncommon occurrence in percutaneous coronary intervention which is often associated with significant morbidity in the form of coronary thrombosis and subsequent myocardial infarction, sudden cardiac death, and acute limb ischaemia [1][2][3]. Manual crimping of stents, something which is rarely practiced these days, was commonly associated with a significantly increased risk of stent dislodgement and embolisation.…”