Unrecoverable stent deformation in the left main: Crush it or remove it?

Abstract

Serial ostial and distal left main lesions continue to be one of the most difficult tasks for the interventional cardiologist, with many potential complications occurring. We present such a high-risk percutaneous coronary intervention where immediate stent explantation was deemed necessary because the metal deformation and high radial strength of the particular stent platform would prevent an acceptable procedural result if it had been crushed to the vessel wall. The aim of this paper was to discuss left main stent deformation, debate the risks and benefits of stent explantation and finally test in-vitro our theory on "insufficient" crush with stents with high radial strength and compare it with conventional stents. Bench-testing supports our ad-hoc explantation decision showing stent underexpansion, recoil, and malapposition, obtaining an inadequate minimal stent area.

The Degree of Stent Apposition Measured by Stent Enhancement at the Level of the Side Branch as a Novel Predictor of Procedural Success in Left Main PCI

“…Potential applications of stent enhancement are: stent underexpansion (it can show suboptimal stent conformation), damage to stent struts (stent deformation), stent overlap (important when implanting a second stent), stent failure (when treating a lesion in a previously stented vessel), aorto-ostial lesions (adequate ostial coverage) and bifurcations (two-stent techniques, adequate POT, proximal vs. distal SB re-wiring or, as in our case, SESBL assessment) [ 23 ]. Imaging will aid operators in lesion preparation, stent selection and stent optimization with post-dilation or extra stent implantation [ 24 , 25 , 26 ]. Longitudinal stent deformation is particularly easy to notice during enhanced stent visualization [ 24 ].…”