Partial stent loss: balloon partially on the stent
Coronary stent loss complications
Partial stent dislodgement and embolisation although infrequent, have not been eliminated entirely and the stent loss itself can be explained by various mechanisms. For instance, a stent can be dislodged by being stripped off the balloon while crossing the tightest coronary artery; it can get partially stuck within the lesion and become separated from the balloon when it is withdrawn; or when withdrawing a deformed stent, a stent tine may catch on the guide tip, leading to the stent being stripped from the balloon. This section explains how to manage this type of complication.
Table of content
Introduction
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.
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? Learn about this technique here.
- Small balloon inflation technique: Find all the steps in the video about small balloon technique.
A joint educational project between PCR and Terumo Learning EDGE - Retrieval technique: 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.
- 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.
- 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!
Inflate stent balloon
Inflate stent balloon at low pressure (3 ATM), and try to retrieve the stent into guiding catheter.
Pass and inflate new small balloon distally
Pass and inflate at 3 ATM a new small balloon (single marker, ≤ 1.5mm) distally and try to retrieve the stent with balloon. If stent/balloon fails to enter the guiding catheter, take everything out en bloc/together.
Key messages:
- Always ensure adequate anticoagulation
- Maintain guidewire position
- Monitor the balloon markers
- Align the guiding catheter during retrieving the lost stent in order to prevent stent flaring, never apply force (risk of stent embolisation)
Additional links
References - Stent loss complications
Case library
Consult the 1st Case study by Tito Kabir: Partial stent loss
More clinical cases will become available shortly!
