Migration of the stent in the left main stem due to poor lesion preparation

#CardioTwitterCase originally published on Twitter

This case was originally published on Twitter by @KPujdak

Case description

In the case presented below, PCI was planned for a highly calcified stenosis of the left main stem. Due to factors mentioned above, a coronary stent was lost in the vessel.

Luckily, it protruded into the aorta, allowing it to be grasped with a snare.

After repeated predilatation with non-compliant balloon and improvement of the guiding catheter, a coronary DES stent could easily be delivered and deployed.

A preferable result on IVUS and angiography was achieved.

Further course of the patient was uneventful.

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Final remarks

Losing a coronary stent in a coronary artery, also known as stent migration, is a rare but serious complication of percutaneous coronary interventions. The most important risk factors that may contribute to this occurrence are as follows:

1. Lesion characteristics:
   Characteristics of the coronary lesion being treated, such as severe tortuosity or heavy calcification, can make stent placement challenging and increase the risk of migration.
2. Inadequate lesion preparation:
   Inadequate lesion preparation can can result in stent placement complications in the stenosis. Aggressive handling of the stent, e.g. pushing it into the stenosis, may result in it becoming detached from the balloon.
3. Guiding catheter position:
   Non-coaxial position of the guiding catheter can also contribute to stripping a stent from the balloon

Author

Krzysztof Pujdak

@KPujdak

Interventional cardiologist / Cardiologist

Herford, Germany

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Migration of the stent in the left main stem due to poor lesion preparation

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