Complications: coronary stent loss

Embolised device complications

Stent loss and embolisation although infrequent (<1% of PCI) since factory crimping was introduced has not been eliminated entirely. Retrieval techniques are technically challenging and evidence for their success is limited to case reports and case series from experienced operators. The key principle for retrieval is to bring the foreign body down into the iliac artery as this removes the risk of embolisation to the cerebrovascular system and or thrombosis in a coronary artery.

The position of the guidewire will be crucial in the choice of the technique. Indeed, some techniques, are not possible in the case of inadvertent removal of the guidewire. Thus, taking great care to keep the wire position inside the stent and across the lesion is of major importance. For stent loss within the coronary circulation the key principle for successful retrieval is to keep the guidewire position secure at all times.

PCR Complications Team: Patrick Calvert, Eric Eeckhout, Michael Haude and Olivier Muller
Medical assistant: Timothy Sze Wah Lai

The 4 main scenarios that can be encountered are:

Partial stent loss in the coronary artery (balloon partially within stent)
Total stent loss in the coronary artery with the guidewire in situ
Total stent and guidewire loss in the coronary artery
Coronary stent loss in the aorta or peripheral circulation

PARTIAL STENT LOSS	Partial stent loss is explained by various mechanisms and how to retrieve it, namely: inflate a low pressure balloon, stent retrieval techniques or stent deployed in situ in 2 steps.	PARTIAL STENT LOSS
TOTAL STENT LOSS WITH GUIDEWIRE IN SITU	What to do when total stent loss occurs in the coronary artery with the guidewire in situ? Various techniques are described for instance, the recrossing technique, snaring technique, multiwire technique and crush techniques.	STENT LOSS WITH GW IN SITU
TOTAL STENT AND GUIDEWIRE LOSS	Find out how to do the snaring, crush or biotome/forceps technique in the event that total stent and guidewire loss occurs in the coronary artery.	STENT AND GW LOSS
STENT LOSS IN AORTA OR PERIPHERAL ARTERIES	Stent loss may occur in the cerebral/carotid arteries, above or below the common femoral artery. The site of stent dislodgement is therefore important. Retrieval techniques in case of the femoral approach or the snaring technique are described.	LOST STENT IN AORTA

Each type of complication is presented in three parts, namely:

Part 1 - Introduction
Part 2 - Management algorithm/decision tree and additional links
Part 3 - Case library

In addition to this complication management resource, further cases on complications are available on the website in the Topics section. Also consult the video on the highly-innovative workshops on bailout techniques that was presented @EuroPCR 2018 this year: Stent dislodgement and balloon dysfunction - bailout steps and techniques during PCI