Intracoronary loss of balloon-mounted stents: Successful retrieval with a 2 mm-“Microsnare”-device

Elsner, Mathias; Peifer, Alfred; Kasper, Wolfgang

doi:10.1002/(sici)1097-0304(199611)39:3<271::aid-ccd13>3.0.co;2-i

Cited by 55 publications

(43 citation statements)

References 15 publications

(11 reference statements)

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“…The Amplatz gooseneck snare (Microvena Corp., White Bear Lake, MN) has a shaft diameter of 0.018 inch and is tipped by a closed wire loop 2 mm in diameter, angulated 90°to the shaft axis [8]. Retraction or advancement of the wire within an outer plastic catheter of 2.3F ("the Wanderer") permits the snare to be opened or closed.…”

Section: Nonsurgical Stent Retrievalmentioning

confidence: 99%

“…Dislodgement of a stent from the delivery balloon during the deployment procedure is a rare complication, reported to occur in 1-8.4% [6,7], and may result in systemic or intracoronary stent embolization. While systemic embolization may cause severe cerebrovascular events [8], intracoronary embolization is associated with a high risk of coronary thrombosis and subsequent myocardial infarction [7,9,10,11]. Bailout cardiac surgery may be indicated [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…For extraction of unexpanded stents from the coronary circulation, different percutaneous techniques have been described, including the use of a biliary or myocardial biopsy forceps [14 -16], multipurpose baskets [14], two twisted guide wires [17], balloon catheters [6,18], or loop snares [8].…”

Section: Introductionmentioning

confidence: 99%

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Nonsurgical retrieval of embolized coronary stents

Eggebrecht

Haude

Birgelen

et al. 2000

Cathet. Cardiovasc. Intervent.

142

133

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Embolization of coronary stents before deployment is a rare but challenging complication of coronary stenting. Different methods for nonsurgical stent retrieval have been suggested. There were 20 cases (0.90%) of intracoronary stent embolization among 2,211 patients who underwent implantation of 4,066 stents. Twelve of 1,147 manually crimped stents (1.04%) and eight of 2,919 premounted stents were lost (0.27%, P < 0.01) during retraction of the delivery system, because the target lesion could not be either reached or crossed. Percutaneous retrieval was successfully carried out in 10 of 14 patients (71%) in whom retrieval was attempted. In 10 patients, stent retrieval was tried with 1.5-mm low-profile angioplasty balloon catheters (success in 7/10) and in seven cases with myocardial biopsy forceps or a gooseneck snare (success in 3/7). Three patients (15%) underwent urgent coronary artery bypass surgery after failed percutaneous retrieval, but their outcomes were fatal. In two patients, stents were compressed against the vessel wall by another stent, without compromising coronary blood flow. In two patients, a stent was lost to the periphery without clinical side effects; treatment was conservative in these cases. Embolization of stents before deployment is a rare but serious complication of coronary stenting, with hazardous potential for the patient. Manual mounting of stents is associated with a significantly higher risk of stent embolization. Stent retrieval from the coronary circulation with low-profile angioplasty balloon catheters is a readily available and technically familiar approach that has a relatively high success rate.

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Section: Nonsurgical Stent Retrievalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nonsurgical retrieval of embolized coronary stents

Eggebrecht

Haude

Birgelen

et al. 2000

Cathet. Cardiovasc. Intervent.

142

133

View full text Add to dashboard Cite

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“…Intracoronary embolization of balloon-mounted stents is a serious complication associated with a high risk of coronary thrombosis and subsequent myocardial infarction [4][5][6][7]. Bailout cardiac surgery may be indicated if percutaneous retrieval attempts fail [8,9].…”

Section: Discussionmentioning

confidence: 99%

Successful Coronary Stent Retrieval From a Pedal Artery

Mariano

Versaci

Gandini

et al. 2007

Cardiovasc Intervent Radiol

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The purpose of this article is to report complications from a coronary drug-eluting stent lost in the peripheral circulation. We report the case of successful retrieval of a sirolimus coronary stent from a pedal artery in a young patient who underwent coronary angiography for previous anterior myocardial infarction. Recognition of stent embolization requires adequate removal of the device to avoid unwelcome clinical sequelae.The occurrence of stent loss during percutaneous coronary interventions appears to have decreased in recent years, probably due to improvements in equipment design and to the almost universal use of premounted stents. Unfortunately, dislodgement of a stent during its deployment is still an unwelcome complication in coronary stenting procedures and has been reported to occur in 1% to 8.4% of cases [1]. This event may result in coronary, cerebral, or peripheral embolization with potentially adverse sequelae [2,3]. Improved deployment strategies, including new stent designs, are required to decrease procedural risk. We report the case of successful coronary stent retrieval in a patient in whom a drug-eluting stent was dislodged from a balloon catheter to the pedal artery after failed intracoronary delivery. Case ReportA 47-year-old man with coronary artery disease was admitted to our hospital because of dyspnoea occurring 2 months after anterior myocardial infarction. Physical examination was normal, whereas the electrocardiogram showed sinus rhythm and signs of previous anteroseptal myocardial infarction. Laboratory parameters were within normal limits.Preoperative transthoracic echocardiography showed fairly decreased left ventricular function (ejection fraction 45%) associated with apical and distal septum wall akinesia and evidence of a thrombus stratification in the apex.Coronary angiography was performed using a standard right femoral approach with the placement of a 6F short sheath. Selective left coronary angiography showed twovessel disease, with evidence of spontaneous dissection in the middle segment of the left anterior descending coronary artery (LAD) and severe narrowing superimposed to an ulcerated plaque in the proximal segment of the right coronary artery (RCA). After coronary revascularization of the RCA, direct stenting of the lesion in the middle tract of the LAD was attempted with a 3.5 · 33-mm Cypher (Cordis Europa, Roden, The Netherlands) stent. During advancement of the stent, the device became entrapped, making it impossible to retrieve the stent in the guiding catheter because of the partial enlargement of its distal struts. Therefore, the guiding catheter and the stent-loaded balloon were carefully brought into the descending aorta as one unit to avoid embolization in the cerebral circulation. Unfortunately, during this manoeuvre the stent was dislodged from

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“…It was not rare when first generation stents were used [1][2][3]. The consequences could includecoronary thrombosis, myo cardial infarction, stroke, perforation and sudden death [4][5][6]. In the past, manual crimping of stents was associated with a significantly increased risk of stent dislodgement and embolisation.…”

Section: Introductionmentioning

confidence: 99%

Retrieval of dislodged stents from left main during percutaneous coronary intervention by trapping technique

et al. 2016

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Dislodgement and embolisation of the new generation of drug eluting stents is a very rare but recognised and potentially serious complication of percutaneous coronary intervention. Various methods, including tangling wire, bioptome, and goose neck snare to surgical removal have been described. Here we report a case of successful retrieval of a deformed coronary stent from left main coronary artery by trapping technique.

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Intracoronary loss of balloon-mounted stents: Successful retrieval with a 2 mm-“Microsnare”-device

Cited by 55 publications

References 15 publications

Nonsurgical retrieval of embolized coronary stents

Nonsurgical retrieval of embolized coronary stents

Successful Coronary Stent Retrieval From a Pedal Artery

Retrieval of dislodged stents from left main during percutaneous coronary intervention by trapping technique

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