title: Percutaneous removal of a fully expanded SMART stent from the pulmonary artery using various adjunctive techniques.
abstract: A 36-year-old man with an implanted arteriovenous shunt for hemodialysis was referred for shunt malfunction. Venography of the right upper extremity showed occlusion of the subclavian vein, and a SMART stent was deployed. The fully expanded stent immediately migrated centrally into the left pulmonary artery. As initial efforts to pass a snare over the stent failed, we intentionally passed a microguidewire through stent interstices, snared the end of the microguidewire to create a loop, and pulled the stent/microguidewire/snare combination back into the right ventricle where it separated from the loop because of stent mesh destruction. As the stent remained in the right ventricle, we advanced a 0.035-in. guidewire into the stent lumen, passed an angioplasty balloon over the guidewire, inflated the balloon in the stent, and performed pull-back into the right distal external iliac artery. The stent was then surgically removed via a right inguinal incision without eliciting any complications. Although retrieval of the stent malpositioned in the pulmonary artery was difficult, we retrieved it safely by applying various adjunctive techniques.
authors.affiliation: Department of Radiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto 861-8520, Japan. sugatake@kumamoto-med.jrc.or.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugahara
authors.forename: Koya
authors.initials: K
authors.lastname: Nakashima
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Suzuki
authors.forename: Koji
authors.initials: K
authors.lastname: Hagio
authors.forename: Minako
authors.initials: M
authors.lastname: Azuma
authors.forename: Kanako
authors.initials: K
authors.lastname: Ito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Baba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uetani
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D020878:Device Removal / Q000379:methods; D004868:Equipment Failure; D006801:Humans; D007083:Iliac Artery; D008297:Male; D011651:Pulmonary Artery; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D015607:Stents