Stent dislodgement is a serious complication during Percutaneous Coronary Interventions (PCI) and potentially responsible for cardiac arrest, a condition requiring a rapid intervention and restoring of coronary and systemic blood flow. Recently, Veno-Arterial ExtraCorporeal Membrane Oxygenation (VA-ECMO) has become readily applicable even in the setting of the catheterization laboratory. In the present paper we report a case of refractory cardiac arrest due to left main thrombosis complicating stent dislodgement, successfully treated with support of VA-ECMO. The patient gave the consent for publication of this anonymous case report.
Clinical CaseA 62-year-old man with multiple risk factors (dyslipidemia, class 1 obesity, type 2 diabetes mellitus, smoking, obstructive sleepapnea syndrome), stable effort angina and a positive stress test was admitted to our Cardiology Department. Coronary angiography carried out through right radial access revealed sub-occlusive stenoses of the proximal Left Anterior Descending (LAD) artery and of the proximal Left Circumflex (LCx) artery, with a 70% stenosis also on the first Obtuse Marginal Branch (OM1) (Figures 1a & 1b) and a chronic total occlusion of the proximal Right Coronary Artery (RCA) (SYNTAX score 22). The patient refused coronary artery bypass grafting; therefore, it was decided to perform angioplasty on LAD, LCx and OM1 after administration of a 600 mg loading dose of clopidogrel and 6500 IU (70 IU/kg) of unfractioned heparin (the patient was already on aspirin at the time of the procedure).A 6-Fr JL 3.5 guiding catheter was used to engage the Left Main (LM) from the right radial access. Firstly, the LAD stenosis was crossed with a 0.014-inch BMW wire (Hi-Torque Balance