Optical coherence tomography assessment of a coronary bare cobalt chromium stent deformed by the removal of an entrapped "jailed" guidewire.
A 64-year-old male with an ongoing acute coronary syndrome was treated percutaneously for a subtotal occlusion of a first diagonal branch. After predilatation of the diagonal, an important secondary branch was evident at the level of the subocclusion. A jailed wire was placed in this vessel, and stenting of the main diagonal branch was performed with a last-generation thin-strut bare cobalt-chromium stent. Conventional retrieval of the jailed wire was impossible, as the distal tip of the wire remained entrapped at the level of the stent. The strong pulling of the wire led only to a deep intubation of the guiding catheter with possible risk of dissection. Retrieval of the wire was finally possible with the support of an over-the-wire microcatheter. However, the stent, though still patent, appeared deformed. At a scheduled control angiogram 4 months later (while the patient was still asymptomatic), an optical coherence tomography (OCT) investigation of the stented segment confirmed the deformation of the stent. OCT showed a complete lack of stent struts on the side of origin of the secondary branch and an "overlap" or "accumulation" of several layers of stent struts on the other side. There were no signs of uncovered struts overall nor malapposition, and even the sites where multiple stent layers were visible were completely covered by neointimal hyperplasia. Despite the multiple layers of metal, the neointimal reaction was moderate and did not lead to a flow-limiting stenosis, thus the patient was further treated medically without the need for a new intervention.
Agostoni
Pierfrancesco
P
University Medical Center Utrecht, Department of Cardiology, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands. agostonipf@gmail.com
Van Belle
Eric
E
Stella
Pieter R
PR
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D002858:Chromium Alloys; D017023:Coronary Angiography; D020878:Device Removal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence
D002858:Chromium Alloys