Diagnosis and treatment of coronary stent entanglement complicated by extreme stent distortion.
A 2.5 x 32 mm Taxus Libert e stent was deployed at high pressure in the proximal right coronary artery (RCA) of a 71-year-old male patient, but the distal part of the lesion remained uncovered. A second stent (Driver 2.5 x 12 mm) could not be advanced through the first one and was withdrawn. The pullback traction resulted in dislodgement of the stent from its delivery balloon. Fluoroscopic examination suggested that the missing stent had traveled to the ascending aorta. Transesophageal echocardiography disclosed a dense, linear, mobile structure in the ascending aorta arising from the right coronary ostium. A 64-multislice computed tomographic scan revealed that both stents were entangled, with the first stent (Taxus 32 mm) elongated (approximately 90 mm in length), and the second one (Driver 12 mm) attached to the tail of the Taxus stent in the aorta. Stent retrieval was performed with a 15 mm snare loop catheter through a 7 Fr femoral sheath. Examination of the retrieved material revealed elongation of the Taxus stent entangled with the Driver stent. This case illustrates the potential for serious complications derived from stent entanglement, even with modern stent platforms, and how integrating noninvasive imaging modalities can provide crucial information regarding the cause of the complication and its solution.
Hernández-Antolín
Rosa Ana
RA
Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, C/Martin Lagos s/n, Madrid, 28040, Spain. rhernandez_antolin@hotmail.com
Suárez
Alfonso
A
Corros
Cecilia
C
D054058:Acute Coronary Syndrome / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology*; D003331:Coronary Vessels / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects*; D036542:Tomography, Spiral Computed; D014656:Vascular Surgical Procedures / Q000379:methods*