Total stent and guidewire loss in coronary artery
Coronary stent loss complications
Total stent loss during coronary angioplasty is a complication that can be managed using a multitude of techniques. Proper anticoagulation should be ensured. Understanding the use of fluoroscopy in identifying the lost device is important. Depending on where the stent loss occurred, such as the left main stem, retrieval techniques other than crushing should be employed. Find out why other techniques, such as multiwire and recrossing techniques are not recommended. Learn about the increasing difficulties from LAD-LCx-RCA. Discover the management overview and details in this section which describes what to do when total stent and guidewire loss occurs in the coronary artery.
Introduction
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.
Management overview
- Snaring 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.
- Bioptome/forceps technique: With clinical tools in constant evolution, choosing the right material for retrieving damaged stents and other devices lost in the peripheral vasculature is critical. Find here a useful reference illustrating what is available today.
- Take a look at the video, which details the snare technique step by step.
A joint educational project between PCR and Terumo Learning EDGE
- 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.
Key messages
- Always ensure adequate anticoagulation
- In case of stent loss in the left main stem, favour use of retrieval technique instead of crushing
- Align the guiding catheter during the retrieving of the lost stent
- Check the stent and balloon integrity after retrieval
- Difficulties increase from LAD-LCx-RCA
- Identify lost stent/scaffold by fluoroscopy
- Multiwire and recrossing technique is not recommended as low successful rate and potentially dangerous
- Biotome technique has been discouraged, delicate to implement but it has been used successfully
Additional links
References - Stent loss complications
Case library
Consult this case study from the Juan Ramon Jimenez Hospital, Huelva - Spain: Is it really loose?
