Retrieval of Migrated Stent From the Left Main Coronary Artery in the Common Iliac Artery

Purpose: Stent migration and loss during percutaneous coronary intervention (PCI) is a rare complication. Migration of deployed stent into peripheral arteries is infrequent and can lead to subsequent peripheral ischemia.

Materials and Methods: A 73-year-old woman with a history of hypertension presented with chest pain. Electrocardiogram revealed T-wave changes in the inferior leads. Regadenoson stress test showed left ventricular ejection fraction of 40% with inferior hypokinesis. She underwent cardiac catheterization, which revealed 70% ostial LM disease and 90% RCA. She declined coronary bypass surgery. She underwent PCI. The LM was ballooned using a 3.5- × 15-mm (Wolverine cutting) balloon. During stent placement (Synergy stent 4.5 × 12 mm), the stent migrated proximally away from the LM artery and disappeared from the field.

Results: The patient was stable without signs of peripheral embolization. We evaluated

the carotid, mesenteric circulation, renal, and finally iliac arteries, where we found the stent in the right common iliac artery. A decision was made to pursue with LM lesion management with a new stent (Synergy 4.5 × 12 mm). Residual disease after stenting was 0%.The migrated stent was retrieved using (0.014 Grand Slam 300-cm) wire with 7-mm gooseneck snare. The arterial access was changed to a 7-Fr sheath because of the size of the stent. The stent was retrieved with the whole system as one unit without complication.

Conclusions: Stent migration into the peripheral arteries is often asymptomatic. However, it can lead thrombosis and cause peripheral ischemia. Attempt for retrieval should be done whatever feasible.