Total stent loss with guidewire in situ
Coronary stent loss complications
Stent loss and embolisation although infrequent has not been eliminated entirely. Total stent loss during interventional treatment of coronary disease is a relatively rare complication, but it may have serious consequences. Stent loss during coronary angioplasty is a complication that can be managed in various manners. This section describes what to do when total stent loss occurs on the guidewire within the coronary artery.
Table of content
Introduction
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.
Management overview
- Low pressure balloon inflation: Do you know what is involved in retrieving a stent into the guiding catheter using low pressure balloon inflation?
- Find all the steps in this video about the small balloon technique.
A joint educational project between PCR and Terumo Learning EDGE
- Find all the steps in this video about the small balloon technique.
- Stent advancement and deployment: What are the different steps involved in this technique? Where is the stent and catheter eventually positioned? What is the ultimate goal? Find out more about how to advance a lost stent here!
- Snare technique: Often used for the retrieval of a stent in cases of inadvertent loss of guidewire position, the snare technique involves several decisions and technical steps. Discover more about this technique here.
- Take a look at the video, which details the snare technique step by step.
A joint educational project between PCR and Terumo Learning EDGE - Additional link: Stiff wire technique with snare.
- Take a look at the video, which details the snare technique step by step.
- Multiwire technique: Total stent loss during percutaneous coronary intervention (PCI) is explained here with the multiwire retrieval techniques. Retrieval techniques are technically challenging and evidence for their success is limited.
- Consult the video about all the steps of the multiwire technique.
A joint educational project between PCR and Terumo Learning EDGE
- Consult the video about all the steps of the multiwire technique.
- Crush technique: What do you do when faced with a dislodged and unexpanded stent? Is the stent crush technique a valid clinical response? Learn the pro’s and con’s of this technique here.
If stent-vessel sizing acceptable
Try to use a small balloon (<2mm) to recross the lost stent and deploy the stent in situ with incremental balloon size.
In case of stent vessel mismatch
Try to advance the lost stent with a slight inflated balloon to appropriate site (use the balloon as pushing device).
Snaring technique
If proximal: use a snaring technique to retrieve the lost stent.
Multiwire technique
If proximal or middle: use a multiwire technique to retrieve the lost stent (stent alignment upon retrieval is essential).
Key messages
- Always ensure adequate anticoagulation
- Maintain guidewire position
- Align the guiding catheter during retrieving the lost stent
- Difficulties increase from LAD-LCx-RCA, alignment of the guiding catheter can be improved by verticalisation or pulling the extra backup guiding catheter
Additional links
References - Stent loss complications
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