title: Incidence, retrieval methods, and outcomes of stent loss during percutaneous coronary intervention: a large single-center experience.
abstract: Our goal was to examine the incidence and consequences of stent loss during percutaneous coronary intervention (PCI) and the retrieval techniques used. We retrospectively reviewed 11,773 consecutive PCI cases involving stents performed at our institution between January 1994 and March 2004 to identify cases of stent loss. Stent loss occurred in 38 of 11,773 PCI procedures involving stents (0.32%; 95% CI = 0.23-0.44%). Mean age of the patients was 67 +/- 11 years and 82% were men. Stent loss occurred more frequently in lesions with calcification and/or significant proximal angulation. In three patients, the stent was crushed and covered with another stent without attempting retrieval. Stent retrieval was attempted in 35 of 38 cases and was successful in 30 (86%). The following retrieval methods were used (more than one method was used in some cases): advancing a balloon through the stent, inflating the balloon, and withdrawing the stent (45%); twirling two wires around the stent (5%); loop snare (26%); biliary forceps (12%); Cook retained fragment retriever (10%); and basket retrieval device (2%). Patients in whom stent loss occurred had a higher incidence of bleeding requiring transfusion (24% vs. 7%; P < 0.001) and more often required emergency coronary artery bypass surgery (5% vs. 0.4%; P < 0.001). No patients in whom the stent was crushed or deployed in the coronary artery had any major cardiac complication. Stent loss during PCI occurs infrequently. Lost stents can be successfully retrieved in the majority of cases using a variety of retrieval techniques, yet stent loss is associated with an increased risk of complications. Stent deployment or crushing may be a good alternative to retrieval.
authors.affiliation: Division of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA. emmanouil.brilakis@utsouthwestern.edu
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Patricia J M
authors.initials: PJ
authors.lastname: Best
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elesber
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Barsness
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome