Fishing stent in femoral artery (A case report of a coronary stent dislogment's retrieval)

Tóm tắt

Background

Stent dislodgement is a rare complication (0.21% to 8.4%) of percutaneous coronary intervention (PCI) procedures that caused peripheral blood circulation disruption, coronary thrombosis or myocardial infarction that led to sudden cardiac death. An urgent intervention should be done to retrieve stent dislodgement such as snaring technique. This case presented a case of coronary stent dislodgement to the right common femoral artery (RFA) during PCI that treated with endovascular snaring technique.

Methods

A 62 years old woman was admitted to our hospital due to a non-ST-elevation acute coronary syndrome. She had a history of previous PCI with stent placement in the osteal to mid left anterior descending (LAD) artery 2 years back. Coronary angiography shown type II LAD in-stent restenosis, diffuse stenosis in distal Left circumflex artery (LCX) and Obtuse Marginal 1 (OM1) (Fig. 1). Patient then proceeded for PCI to LAD using right femoral approach, with 7Fr guiding catheter and coronary guiding wire to LAD and LCX. After stent implantation to LM-LAD (3.5x16mm), LCX wire was trapped under the stent. During the attempt to pull LCX wire, the stent was dislodged to RFA (Fig. 2).

Results

The RFA Sheath and catheter then removed and left femoral artery (LFA) sheath was inserted. By using 7Fr JR Guiding and One Snare Endovascular snare system, the dislodged stent was successfully retrieved and removed from femoral artery (Fig. 3A and 3B). During retrieval the right femoral artery sustained no angiographically obvious injuries, the patient remained well, and the PCI continued by inserted 1 stent amphilimus 3.5x38 mm in distal LM to mid LAD. The patient hemodynamic was stable until the procedure had finished.

Conclusion

Stent dislodgement was associated with poor vessel preparation, calcificiation, previously stented vessels, small stents, tortuous coronary arteries, and severe angulation of the vessel.  In this case the cause of stent dislodgment probably poor vessel preparation and calcificiation. Stent dislodgement during a percutaneous coronary intervention (PCI) procedure can become life threatening. Therefore, interventional cardiologists should think several retrieval methods such as using a loop snare, small-balloon catheter, double wire, and forceps. Because the available equipment from catheterization lab was ONE Snare^® 6Fr endovascular snaring device, we used it and without resistance passed through, enabling us to successfully and retrieve a lost stent in RFA