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Embolised device complications can be classified in a variety of ways but are traditionally described either in relation to disease indication, the general phases of a procedure, or the use of specific devices. These types of complications can be life threatening, but if acting quickly and managed correctly can have a positive outcome. There are a number of categories, for instance coronary embolised devices (stent loss, lost scaffolds, guidewire loss, balloon fracture, rotablator); embolised devices in structural heart disease; or embolised venous catheters.
PCR Complications Team: Patrick Calvert, Eric Eeckhout, Michael Haude and Olivier Muller
Medical assistant: Timothy Sze Wah Lai, Julien Adjedj, Stephane Fournier
Table of content
The first section focuses on how to manage Coronary implant loss, consult the links below or click here to start your educational journey on the management of metallic stent loss (A). Also discover the new section on scaffold loss (B).
Coronary stent loss and embolisation although infrequent has not been eliminated entirely. The most frequently lost device is a stent, slipping of the delivery balloon in the coronary circulation. Dislodgement of a stent may result in systemic embolisation and cause cerebrovascular events, whereas intracoronary embolisation is associated with an increased risk of coronary thombosis and myocardial infarction. Knowledge of the percutaneous management of this rare complication could avoid bail-out cardiac surgery and serious complications like stroke, myocardial infarction or death.
While stent loss and embolisation are infrequent since factory crimping was introduced, they have not been eliminated entirely. Retrieval techniques are technically challenging and the position of the guidewire is critical. Learn how to recover a dislodged coronary metallic stent here.
1. Partial Stent Loss: Partial stent loss can be caused by a variety of mechanisms linked to different problems with the balloon. Learn techniques to manage this complication in this section.
2. Total stent loss with guidewire in situ: While full stent loss during coronary angioplasty is a relatively rare complication it can be managed in various ways. In this section, learn what to do when this occurs in the coronary artery with the guidewire in situ.
3. Total stent and guidewire loss: Can total stent loss during coronary angioplasty be managed? From proper anticoagulation to techniques involved in the identification and successful recovery of the lost device, this section introduces the various ways you can effectively deal with this complication.
4. Stent loss in the aorta/pheripheral circulation: Stent loss occurring in certain parts of the cerebral/carotid arteries can lead to acute ischaemic events due to thromboembolic occlusion. Discover where this is likely to occur and other details about this complication.
Faced with scaffold-loss, find out how image enhancement technology could be used to identify radiopaque scaffold markers and discover the step-by-step approach to managing this type of coronary complication here.
5. Scaffold lost on wire: In this website section learn how to manage scaffold loss complications when the the scaffold is lost on the wire. Discover the clinical steps to take when scaffold loss occurs in the coronary artery with the guidewire in situ.
6. Scaffold lost off wire: How do you manage scaffold loss complications when the loss is off the wire? Learn how to proceed and when to stop in this step-by-step approach.
Devices that can dislodge, brake, embolise or become entrapped in the coronary tree include stents, scaffolds, coronary guidewires, balloons and rotablator burrs. Guidewire loss may be rare, but a fracture can occur, caught in or outside the stent. Do you know the tools and techniques to ensure retrieval? Follow the different step-by-step approaches explained here…
Complications related to balloon technology have become very rare. However during PCI, it could happen that a balloon becomes entrapped, that a balloon shaft fractures or balloon dysfunction occurs. Lean how to manage these coronary complications here...
Rotational Atherectomy (RA), a proven and valuable procedure, is a dedicated technique for calcified lesions. Complications related to the Rotablator system have become relatively rare, but they can occur. Learn valuable tips & tricks in this section.
Access Rotablator Complications
In addition to this complication management resource, further cases on complications are available on the website in the Topics section.
