2 cases of non-surgical treatment of stent loss during percutaneous coronary intervention

Author(s): Mohamed Aymen Ben Abdessalem*, Oussama Ben Rejeb, Imen Bouhlel, Abdallah Mahdhaoui, Samia Ernez and Gouider Jeridi Centre Hospitalier Universitaire Farhat Hached de Sousse sousse, sousse Tunisia

Background: Percutaneous coronary intervention with stents is widely used for coronary artery disease. Stent loss is a rare complication. Incidence is estimated at 1.3%. Although Stent has been retrieved in most cases; urgent coronary artery bypass graft, myocardial infarction and death are poor outcomes associated with this complication. Cases report: First case is about a 55 years old male, heavy smoker, admitted to the cathlab for a non ST elevation myocardial infarction (NSTEMI). Ejection fraction (EF) was 55% with inferior wall hypokinesis. Coronary angiogram showed a long stenosis in a tortuous mid-right coronary artery (RCA) with a TIMI 2 flow. Ad-hoc angioplasty was attempted. Direct stenting was attempted but stent couldn't be delivered to the target lesion and attempts resulted in stent retention. Stent couldn't be retrieved and finally was successfully crushed with a drug eluting stent with good final result. Patient had uneventful recovery. Second case is about a 59 years old Male type 2 diabetes mellitus and former smoker. He was hospitalized for a NSTEMI. EF was 50% with anterior hypokinesis. Angiogram showed a long stenosis in the mid left anterior descending artery with a TIMI 2 flow. Ad-hoc angioplasty was attempted with a long drug eluting stent (DES) but wasn't successful. The stent was partially detached and deformed. It was successfully retrieved using the stent's balloon. Patient was successfully treated with a second successful procedure with a DES. Conclusion: No algorithm or stepwise approach exists to treat stent loss. Tortuous lesions and failure to cross the stenosis are common angiographic finding associated with this complication. Stent retrieval, deployment or crushing is the frequently used techniques to deal with this issue.

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