Stent Dislodgement During Coronary Angioplasty Complicated by Left Main Thrombosis: Application of VA-ECMO in The Catheterization Laboratory

Abstract

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

Slippage of an undeployed stent in the left main artery: A case report study

“…This serious issue might increase the risk of intracoronary thrombosis and myocardial infarction. [ 6 ] There are several reported retrieval techniques for dislodged stents, such as the use of two wires around the stent, stent crushing, or inflating another catheter balloon at the distal end of the slipped stent. [ 5 ]…”