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Arous S, Zahidi H, El Ghali Benouna M, Habbal R. Two stents' dislodgement in the left main coronary artery: a case report. J Med Case Rep 2024; 18:158. [PMID: 38494477 PMCID: PMC10946172 DOI: 10.1186/s13256-024-04491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Stent dislodgement is a life-threatening complication that can result in coronary artery embolization, stent thrombosis, acute myocardial infarction, and even death. Severely angulated, heavily calcified, and previously stented coronary arteries are associated risk factors. With the development of different lesion preparation techniques and the drug eluting stent era, the reported incidence of stent dislodgement has decreased to < 1% in the last few years. CASE PRESENTATION We report a case of a 64-year-old Moroccan man complicated during percutaneous intervention in the left main artery by the loss of two stents. This complication was successfully managed by passing the stent's balloon into the stent and then fully expanding it. In our case, the device's characteristics were involved and could play a role in such complications, but it is still not well understood. CONCLUSIONS The main treatment option is stent retrieval with different available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.
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Affiliation(s)
- Salim Arous
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
| | - Hatim Zahidi
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
| | | | - Rachida Habbal
- Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
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Bouziane Z, Malikov S, Bracard S, Fouilhé L, Berger L, Settembre N. Endovascular Treatment of Aortic Arch Vessel Stent Migration: Three Case Reports. Ann Vasc Surg 2019; 59:313.e11-313.e17. [DOI: 10.1016/j.avsg.2019.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
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Chung WJ, Takeji Y, Soga Y, Ando K. Dog-bone inflation to salvage and redeploy a deformed, dislodged expandable stent in the external iliac artery. J Cardiol Cases 2017; 17:1-3. [PMID: 30279841 DOI: 10.1016/j.jccase.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 10/18/2022] Open
Abstract
A 64-year-old man with a history of right external iliac artery stenosis after stenting with a self-expandable stent was admitted for repetitive in-stent restenosis (ISR). To treat ISR, we selected a balloon expandable stent (BES) that was prepared with negative suction before being inserted into the sheath. BES dislodged when the stent balloon was incompletely inflated and was simultaneously deformed in a funnel shape. When BES was retrieved using a short noncompliant balloon, it dislodged again because of an imbalanced proximal inflation of the balloon. We finally retrieved BES using a long noncompliant balloon and deployed it with dog-bone inflation without any additional devices. <Learning objective: To report an easy method for retrieving and redeploying a deformed, dislodged stent without using an additional device. Retrieving a relatively large peripheral stent that becomes deformed and dislodged is difficult and may require surgery. Balloon catheter retrieval is a useful strategy to salvage and redeploy the dislodged stent. However, a large size short noncompliant balloon catheter had the risk for dislodging the retrieved deformed stent again. To retrieve and salvage a deformed and dislodged stent, a long balloon and dog-bone inflation may be useful.>.
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Affiliation(s)
- Wen-Jung Chung
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yasuaki Takeji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Bonvini RF, Werner KD, Buettner HJ, Buergelin KH, Zeller T. Retrieval of lost coronary guidewires during challenging percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 11:262.e7-10. [PMID: 20934661 DOI: 10.1016/j.carrev.2009.04.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The presence of symptomatic or asymptomatic intravascular/intracardiac foreign body (FB) is underreported in the literature, but it is more commonly encountered in clinical practice. Nowadays, losing a coronary stent or a guidewire has become a rare event. However, due to the constant increase in the total number of worldwide performed coronary interventions (PCI) and especially due to an increase also in the technical difficulties of these procedures (i.e., new devices+complex techniques), this kind of "lost FB complication" may again become clinically relevant. CASE REPORTS We report two cases where, during challenging PCIs, 0.014-in. guidewires broke, remaining firmly anchored in the coronary tree floating with their proximal part in the aorta. These wires could have been successfully retrieved with a dedicated three-dimensional snare device, which is specifically manufactured for facilitating this kind of retrieval interventions. CONCLUSIONS Intracoronary lost guidewires, if untreated, may lead to serious cardiovascular complications, suggesting that one should attempt every possible maneuver to retrieve them from the coronary circulation. By describing the peculiarity of the Entrio snare device, we finally suggest that this kind of dedicated three-dimensional snare device is an excellent tool at cardiologists' disposal for retrieving intracardiac and intravascular lost wires.
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Complete atrioventricular block due to venous stent migration from innominated vein to right ventricle: A case report. J Cardiol 2009; 53:453-7. [DOI: 10.1016/j.jjcc.2008.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 08/29/2008] [Accepted: 09/03/2008] [Indexed: 11/22/2022]
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Bonvini RF, Rastan A, Sixt S, Noory E, Beschorner U, Leppanen O, Mach F, Schwarzwälder U, Bürgelin K, Zeller T. Percutaneous retrieval of intravascular and intracardiac foreign bodies with a dedicated three-dimensional snare: A 3-year single center experience. Catheter Cardiovasc Interv 2009; 74:939-45. [DOI: 10.1002/ccd.22074] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 47:450-3. [PMID: 18241769 DOI: 10.1016/j.jvs.2007.08.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 08/10/2007] [Accepted: 08/22/2007] [Indexed: 11/21/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) is being performed more frequently in patients with concomitant iliac artery occlusive disease. We report a case of a 70-year-old male status post angioplasty and stenting of bilateral iliac arteries for occlusive disease who subsequently underwent EVAR for a rapidly expanding abdominal aortic aneurysm (AAA). One month after the placement of the endograft, it was discovered that the previously placed Wallstent had been dislodged during the endovascular abdominal aortic aneurysm repair. Minimally invasive retrieval using an Amplatz Goose Neck Snare was successful in recovering the stent. This case underscores the danger of performing EVAR in the setting of prior iliac artery stenting and the potential complications that may ensue.
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Mariano E, Versaci F, Gandini R, Simonetti G, Di Vito L, Romeo F. Successful coronary stent retrieval from a pedal artery. Cardiovasc Intervent Radiol 2007; 31:655-8. [PMID: 17710470 DOI: 10.1007/s00270-007-9151-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/14/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Enrica Mariano
- Department of Cardiology, Tor Vergata University, Rome, Italy.
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Brilakis ES, Best PJM, Elesber AA, Barsness GW, Lennon RJ, Holmes DR, Rihal CS, Garratt KN. Incidence, retrieval methods, and outcomes of stent loss during percutaneous coronary intervention: a large single-center experience. Catheter Cardiovasc Interv 2006; 66:333-40. [PMID: 16142808 DOI: 10.1002/ccd.20449] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our goal was to examine the incidence and consequences of stent loss during percutaneous coronary intervention (PCI) and the retrieval techniques used. We retrospectively reviewed 11,773 consecutive PCI cases involving stents performed at our institution between January 1994 and March 2004 to identify cases of stent loss. Stent loss occurred in 38 of 11,773 PCI procedures involving stents (0.32%; 95% CI = 0.23-0.44%). Mean age of the patients was 67 +/- 11 years and 82% were men. Stent loss occurred more frequently in lesions with calcification and/or significant proximal angulation. In three patients, the stent was crushed and covered with another stent without attempting retrieval. Stent retrieval was attempted in 35 of 38 cases and was successful in 30 (86%). The following retrieval methods were used (more than one method was used in some cases): advancing a balloon through the stent, inflating the balloon, and withdrawing the stent (45%); twirling two wires around the stent (5%); loop snare (26%); biliary forceps (12%); Cook retained fragment retriever (10%); and basket retrieval device (2%). Patients in whom stent loss occurred had a higher incidence of bleeding requiring transfusion (24% vs. 7%; P < 0.001) and more often required emergency coronary artery bypass surgery (5% vs. 0.4%; P < 0.001). No patients in whom the stent was crushed or deployed in the coronary artery had any major cardiac complication. Stent loss during PCI occurs infrequently. Lost stents can be successfully retrieved in the majority of cases using a variety of retrieval techniques, yet stent loss is associated with an increased risk of complications. Stent deployment or crushing may be a good alternative to retrieval.
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Affiliation(s)
- Emmanouil S Brilakis
- Division of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
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Patterson M, Slagboom T. Intracoronary stent dislodgment: updated strategy enabled by the new generation of materials. Catheter Cardiovasc Interv 2006; 67:386-90. [PMID: 16475180 DOI: 10.1002/ccd.20632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stent dislodgment remains a vexing problem in percutaneous coronary intervention. The technological improvements in machine-crimped premounted stents have led to a reduced incidence of dislodgment but may have exacerbated the problem of stent dislodgment (SD). Previous reports describing the management of SD have concentrated predominantly on manually mounted stents. We present a case where the position of a dislodged premounted stent in the distal left main stem was unfavorable for previously described solutions. The problem was elegantly resolved by taking advantage of the improved performance of the current generation of wires and balloons to achieve a rapid first-rate clinical outcome.
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Affiliation(s)
- Mark Patterson
- Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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Curran PJ, Currier J, Tobis J. Percutaneous snare retrieval of a partially embedded wallstent. Catheter Cardiovasc Interv 2004; 61:400-2. [PMID: 14988904 DOI: 10.1002/ccd.10792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although removal of a stent is a well described method for treating an acutely dislodged or embolized device, removal of a previously deployed stent is unusual. We describe a case where a partially dislodged wallstent in a saphenous vein graft was removed using a snare to permit deployment of a balloon mounted stent across a proximal vein graft stenosis.
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Affiliation(s)
- Peter J Curran
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California 90095, USA
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Abstract
The aim of the study was to determine the incidence of lost or misplaced stents and to identify associated immediate- and long-term consequences. The study reviewed 11,881 cases with one or more intracoronary stents. From this group 40 cases were identified where stents were prematurely displaced from the stent delivery device. Sixteen were removed with bioptomes or snares. Three were removed surgically. Of the 21 remaining stents, 7 were deployed at a site remote from the target lesion and 14 were lost. Nine of the 14 were known to be below the aortoilliac bifurcation and the other 5 embolized to unknown locations. Stent loss is rare in intracoronary intervention. Removal or peripheral deployment is the best option, but there was no immediate or long-term morbidity associated with lost stents in this study.
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Affiliation(s)
- Dennis W Dunning
- Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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Kitchens C, Jordan W, Wirthlin D, Whitley D. Vascular complications arising from maldeployed stents. Vasc Endovascular Surg 2002; 36:145-54. [PMID: 11951101 DOI: 10.1177/153857440203600209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present 6 unusual vascular complications secondary to maldeployed or undeployed vascular stents. They retrospectively reviewed patients referred for complications of vascular stent placement from September 1998 to March 1999. Information on patient history was obtained from a computerized database and clinical document file. Radiographic information was obtained from arteriograms, ultrasound, and computed tomography imaging. Case 1 describes an undeployed stent in the superior mesenteric artery with subsequent thrombosis in addition to celiac occlusion secondary to attempted balloon angioplasty. Case 2 refers to a malpositioned stent placed in the aortic arch and proximal left common carotid artery. Case 3 involves an undeployed coronary stent that migrated to the right distal posterior tibial artery, causing vascular occlusion and chronic pain. In Case 4, an attempted stent placement into the left iliac artery resulted in an undeployed stent lodged across the aortic bifurcation. Case 5 illustrates a partially deployed stent occluding the left renal artery that was unamenable to further angioplasty. Case 6 demonstrates arterial dissection with a pseudoaneurysm following stent placement for right subclavian stenosis. Five patients required operative intervention. Increased use of stents may escalate the number of complications requiring operative intervention. Foreign bodies can migrate distally and potentiate thrombotic occlusion of vessels. Caution must be used not only at the time of deployment but also in the follow-up period. Continued surveillance becomes important after vascular stent placement.
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Affiliation(s)
- Cliff Kitchens
- Department of Surgery, University of Alabama at Birmingham, 1922 Seventh Avenue South, Birmingham, AL 35294-0007, USA
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Eggebrecht H, Haude M, von Birgelen C, Oldenburg O, Baumgart D, Herrmann J, Welge D, Bartel T, Dagres N, Erbel R. Nonsurgical retrieval of embolized coronary stents. Catheter Cardiovasc Interv 2000; 51:432-40. [PMID: 11108675 DOI: 10.1002/1522-726x(200012)51:4<432::aid-ccd12>3.0.co;2-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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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Affiliation(s)
- H Eggebrecht
- Department of Cardiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany.
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Abstract
We report a technique for retrieval of a broken angioplasty wire fragment from the coronary system using a more simplified technique that does not involve the use of a snare or any other retrieval tool. With the use of an additional angioplasty wire and a balloon catheter, we could safely remove the broken wire fragment from the coronary system and circulation in a very short time.
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Affiliation(s)
- T Patel
- Krishna Heart Institute, Ahmedabad, India.
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