Strecker stent migration to the pulmonary artery: long-term result of a "wait-and-see attitude"

Abstract

Accidental dislodgement of an endoprosthesis into the right cavities or the pulmonary artery is a rarely described complication of percutaneous venous stenting. In such cases the migrated stent needs to be promptly extracted by percutaneous techniques in order to avoid any major complication. We report the first case of a delayed Strecker stent migration from the left innominate vein into the right pulmonary artery, successfully managed with anticoagulant therapy and a "wait-and-see" attitude. The advanced stage-disease (metastatic cancer patient) and the large-caliber stent in a disease-free pulmonary artery led us to adopt this unorthodox attitude, as compared with the current clinical practice.

Combined Lung Transplantation and Extraction of a Misplaced Superior Vena Cava Stent From the Right Ventricle

“…Although some authors advocate the "wait-and-see attitude" after SVC stent migration, there is one case with mortality due to pulmonary artery thrombosis and pulmonary infarction (3). However in the present case, the intervention failed as the stent was trapped in the right ventricle.…”

“…While the most common cause is malignancy with up to 90% of all cases, the most common cause of benign SVC syndrome is the use of intravascular devices such as catheters and pacemakers (1). However, a rare complication of stent displacement in the right atrium, right ventricle, or pulmonary artery is described (3). The implantation of an endovascular stent restores venous return and alleviates symptoms (3).…”

“…The implantation of an endovascular stent restores venous return and alleviates symptoms (3). However, a rare complication of stent displacement in the right atrium, right ventricle, or pulmonary artery is described (3).…”

Endovascular Stent Migration to the Right Ventricle Causing Myocardial Injury

“…Causes of stent migration include poor insertion technique (too small stent, balloon rupture, or dislodged stent from the balloon) and excess mobility; for example, around the shoulder joint with the stent working its way loose (6). Migrated stents have been reported in the pulmonary artery (4,7), right atrium (8), and right ventricle (9). Most of the patients were asymptomatic, but some developed severe complications, such as pulmonary infarction (10), severe tricuspid regurgitation (6,9), cardiogenic shock (11), and AMI (12–14).…”

“…Stent migration is a recognized complication of endovascular stents. The incidence is reported to be as low as 3% (4). Management options for stent migration include conservative treatment, percutaneous retrieval, and open surgery.…”