Stent Dislodgment and Retrieval During Percutaneous Coronary Intervention

Keywords: complication, goose neck, stent dislodgment, stent retrieval

An 80-year-old man was admitted for acute coronary syndrome with ST elevation in the anterior leads. Primary percutaneous coronary intervention (PCI) was performed on the left anterior coronary artery by implanting 3 drug-eluting stents. After 48 hours, we planned PCI on severe stenosis of the ostial and proximal right coronary artery (RCA) (Figure 1A).

We engaged the RCA with a JR 4.0, 6-Fr sidehole guiding catheter through the right radial artery access and put 2 coronary guidewires in the distal RCA and acute marginal branch. We predilated the proximal and ostial lesions with a noncompliant balloon catheter (2.75 x 20 mm) with good angiographic expansion (Figure 1B). While advancing a 3.0 x 30-mm Resolute Onyx zotarolimus-eluting stent (Medtronic) through the RCA ostium, we noticed the sudden and complete dislodgment of the stent from the delivery balloon. As a result, approximately half of the stent was entrapped in the ostial-proximal RCA and the remaining proximal half extended back into the aorta (Figure 1C). Despite this, the patient remained asymptomatic and hemodynamically stable, with normal coronary flow and no electrocardiographic changes.

We proceeded with stent retrieval using a 4-mm Amplatz Goose Neck Microsnare Kit (ev3), which allowed us to catch the proximal struts (Video 1). Due to the deformation of its tip (Figure 1D), we could not completely retrieve the stent into the guiding catheter, so we extracted the entire stent and guiding catheter together through the right radial introducer (Figure 1E).

After repositioning a new guiding catheter and coronary guidewire, we proceeded to implant 3 drug-eluting stents in the proximal-ostial RCA and mid RCA with good final angiographic result and Thrombolysis in Myocardial Infarction grade 3 flow (Video 2).

During PCI, stent entrapment and dislodgment in the coronary arteries is a rare but potentially fatal complication that can lead to emergent cardiac surgery. Percutaneous stent retrieval is an alternative way to solve this challenging complication while avoiding cardiac surgery.

Affiliations and Disclosures

From the Unità Operativa Complessa di Cardiologia Clinica e Interventistica, Ospedale SS Annunziata, Sassari, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted February 8, 2022.

Address for correspondence: Giovanni Lorenzoni, MD, Unità Operativa Complessa di Cardiologia Clinica e Interventistica, Ospedale SS Annunziata, Sassari, Italy. Email: giovannilorenzoni@alice.it.

Related Articles

• Patient Specific Coronary Artery Bypass Graft 3D-Printing: Implications for Procedural Planning in Complex Percutaneous Coronary Interventions
• Perforation of an Aortopulmonary Collateral: A Scary Sight in the Lab!
• Ten-Year Clinical Outcomes in Patients With Acute Coronary Syndrome Treated With Biodegradable, Permanent-Polymer or Polymer-Free Drug-Eluting Stents
• Challenges in Primary PCI: How to Treat a Large Intracoronary Thrombus With TIMI 3 Flow?