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.
PARTIAL STENT LOSS
Partial stent dislodgement and embolisation although infrequent has not been eliminated entirely. Partial stent loss is explained by various mechanisms.
Low pressure balloon inflation (3 ATM) and stent retrieved into the guide catheter
Small balloon inflated below the stent and stent retrieved
Stent deployed in-situ in 2 steps
TOTAL STENT LOSS WITH GUIDEWIRE IN-SITU
What to do when total stent loss occurs in the coronary artery with the guidewire in-situ?
Recrossing the stent loss with small balloon or advance with slightly inflated balloon to deliver and deploy the stent at target site
Description text on snaring technique ...
Total stent loss during PCI is explained here with examples of successful or failed multiwire techniques.
Description text of crush technique ...
TOTAL STENT AND GUIDEWIRE LOSS
What to do when total stent and guidewire (GW) loss occurs in the coronary artery.
Description text here of rewire and balloon technique...
Rewire and balloon technique
Description text here of snaring technique...
Description text here of multiwire technique...
Description text here of biotome/forceps technique...
Description text here of crush technique...
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.
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
Use DSA/supra-aortic CT scan
Use conservative management
Each type of complication is presented in three parts, namely:
In addition to this complication management resource, further cases on complications are available on the website in the Topics section.