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

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.

Intentional removal of erroneously deployed coronary stents: A case series and review of the literature

“…We identified 17 reports of complete extraction of fully deployed coronary stents 2‐16 . Although many of the cases involved extraction of just deployed or recently deployed stents, 2‐9 there were seven cases in which the removed stents were implanted between 2 and 10 months earlier 10‐16 . In 13 of the 17 cases, stent extraction was unintentional 3‐6,9‐16 .…”

“…These inadvertent extractions occurred due to the previously deployed stents becoming entrapped or entangled on dislodged stents, guidewires, cutting balloons, aspiration thrombectomy devices, or IVUS catheters 3‐6,9‐16 . In only 4 of the 17 cases, the authors reported intentional retrieval of newly or recently deployed stents that had become deformed or entrapped 2,7,8 . Overall, in the majority of the cases, the retrieved, fully deployed stents were caught on equipment or devices and were removed en bloc from the coronary artery during withdrawal of the equipment 3,4,6,9,11,13‐16 .…”

“…Overall, in the majority of the cases, the retrieved, fully deployed stents were caught on equipment or devices and were removed en bloc from the coronary artery during withdrawal of the equipment 3,4,6,9,11,13‐16 . Stent retrieval devices were used to remove the previously fully deployed stents in 6 of the 17 cases, although, the initial intended use of the retrieval devices was to remove the entrapped or entangled equipment or dislodged stents, rather than intentionally remove the previously fully deployed stent 2,7,8,10,12 . The most commonly utilized retrieval devices were snares, although, one operator used biliary forceps and another employed the “twisted wire” technique 2,5,7,8,10,12 .…”

“…Stent retrieval devices were used to remove the previously fully deployed stents in 6 of the 17 cases, although, the initial intended use of the retrieval devices was to remove the entrapped or entangled equipment or dislodged stents, rather than intentionally remove the previously fully deployed stent 2,7,8,10,12 . The most commonly utilized retrieval devices were snares, although, one operator used biliary forceps and another employed the “twisted wire” technique 2,5,7,8,10,12 . Complications of stent extraction reportedly included acute vessel occlusion or closure in three cases 9,11,13 and dissection or worsened dissection in four cases 2,7,15 .…”

“…The most commonly utilized retrieval devices were snares, although, one operator used biliary forceps and another employed the “twisted wire” technique 2,5,7,8,10,12 . Complications of stent extraction reportedly included acute vessel occlusion or closure in three cases 9,11,13 and dissection or worsened dissection in four cases 2,7,15 . Of the three cases that were complicated by acute vessel closure or occlusion, two cases involved extraction of stents that had been implanted between 4 and 6 months previously 11,13 and one case involved extraction of a newly deployed stent 9 .…”