Coronary stent loss Frontpage (backup v1.4)

Embolised device complications

Stent loss and embolisation although infrequent (<1% of PCI) since factory crimping was introduced, have 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 MullerMedical assistant: Timothy Lai Sze Wah

Scenarios that can be encountered are:
  1. Partial stent loss in the coronary artery (balloon partially within stent)
  2. Total stent loss in the coronary artery with the guidewire in-situ
  3. Total stent and guidewire loss in the coronary artery
  4. Coronary stent loss in the aorta or peripheral circulation

PARTIAL STENT LOSS

Partial stent dislodgement and embolisation although infrequent has not been eliminated entirely. Partial stent loss is explained by various mechanisms.

PARTIAL STENT LOSS

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Low pressure balloon inflation (3 ATM) and stent retrieved into the guide catheter

Low pressure balloon

 

Small balloon inflated below the stent and stent retrieved

Retrieval technique

 

Stent deployed in-situ in 2 steps

Stent deployment

TOTAL STENT LOSS WITH GUIDEWIRE IN-SITU

What to do when total stent loss occurs in the coronary artery with the guidewire in-situ?

STENT LOSS WITH GW IN-SITU

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Recrossing the stent loss with small balloon or advance with slightly inflated balloon to deliver and deploy the stent at target site

Recrossing technique

Description text on snaring technique ...

Snares and forceps comparison table

Total stent loss during PCI is explained here with examples of successful or failed multiwire techniques.

Multiwire technique

Description text of crush technique ...

Crush technique

TOTAL STENT AND GUIDEWIRE LOSS

What to do when total stent and guidewire (GW) loss occurs in the coronary artery.

STENT AND GW LOSS

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Description text here of rewire and balloon technique...

Rewire and balloon technique

Description text here of snaring technique...

Snares and forceps comparison table

Description text here of multiwire technique...

Multiwire technique

Description text here of biotome/forceps technique...

Biotome/forceps technique

Description text here of crush technique...

Crush technique

UNCLASSIFIED CASES

Description of stent around guiding catheter (GC)

Stent around GC

Description of migration to contralateral artery

Migration to contralateral artery

Description of migration to renal artery

Migration to renal artery

CORONARY STENT IN AORTA OR PERIPHERAL ARTERIES

Stent loss may occur in the cerebral/carotid arteries, above the left subclavian artery or above the femoral sheath. The site of stent dislodgement is important.

STENT IN AORTA/PERIPHERAL ARTERIES

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Above left subclavian artery

Stent loss without guidewire (GW): snaring technique in upper vasculature

Snaring technique in upper vasculature

Above femoral sheath

Stent loss by femoral access: contralateral femoral approach

3 Foil basket snaring

Use DSA/supra-aortic CT scan

Use conservative management

Conservative management


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.

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