Stent accordion phenomenon visualized with optical coherence tomography

Abstract

Percutaneous coronary intervention (PCI) was done in a 57-year-old male with chronic kidney disease who presented with non-ST segment elevation myocardial infarction. Coronary angiogram showed two vessel disease of the left anterior descending artery (LAD) and the right coronary artery (RCA). The LAD was successfully stented. After predilatation and rotablation, PCI was performed with 2 overlapping drug eluting stents (DES) Promus (Boston Scientific, Marlborough, Massachusetts, USA) 3 mm × 38 mm to the mid RCA and Resolute Onyx 3.5 mm × 34 mm (Medtronic, Minneapolis, Minnesota, USA) to the ostial proximal segment, respectively. After post dilatation using a 3.5 non-compliant balloon, there was a stenotic segment at the ostial area where the stent was implanted (white arrowhead Figures 1,2). The patient was asymptomatic and no changes in the electrocardiogram were noted. However, the ostial stenosis did not resolve despite administration of intracoronary nitrates. Optical coherence tomography showed longitudinal deformation/compression of the ostial RCA stent (white arrowhead Figures 1B,3). Some of the proximal stent struts were well apposed but is visualized alongside distorted and crumpled malapposed stent struts (white arrowhead Figures 1C,3). Despite prior ostial stent deployment, there was a stenosis at the ostial area right before the guide catheter and no stent struts can be visualized on three-dimensional rendering (white arrowhead Figure 1D). The deformed portion of the ostial RCA was stented further with a DES (Ultimaster 4.0 mm × 12 mm, Terumo, Shibuya, Tokyo, Japan). Postdilatation was completed with 4.0 non-compliant balloon and adequate stent expansion and apposition was achieved. Patient was maintained on dual antiplatelet therapy and the rest of the hospital stay was unremarkable.Longitudinal stent deformation or the accordion phenomenon is an unusual but increasingly recognized complication after percutaneous catheter interventions, characterized by mechanical distortion or shortening of a stent in the longitudinal axis after deployment. Data from the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database revealed an occurrence of 0.2% in a span of 4 years (3). Other names such as concertina-like, pseudofracture, pseudostenosis and crumpling have been used synonymously to describe its characteristic appearance. It should be suspected angiographically by the appearance of new onset stenosis after stent deployment that can be sometimes mistaken for spasm and is persistent despite nitroglycerin administration. In our case the accordion phenomenon may have been caused by the interaction of the guiding catheter and stent deployed in the aortoostial position. It is possible that stents that are relatively undersized after initial deployment are subsequently 'caught' and distorted by secondary equipment that is passed into the coronary vessel with compression of the proximal edge of ostially placed stent with the guide catheter (4). It can be also induc...

Longitudinal Stent Deformation at the Proximal Segment of the Left Main Coronary Artery Caused by a Stuck OCT Catheter: Case Report and Review of Literature

“…Our study was conducted based on previous studies and a review of LSD cases (Table 1 , Ref. [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]). Furthermore, we thoroughly examined the existing literature on LSD.…”

“…Furthermore, the incidence of LSD may increase if IVUS or OCT is routinely performed after coronary stenting. If LSD is suspected after a detailed analysis of angiography after stenting, further diagnostic procedures such as IVUS or OCT should be considered to provide a more definitive diagnosis and guide subsequent interventional management [ 6 , 7 ].…”