Accidental Stenting Out of Stent: A Lesson from No-Reflow after New Stent Deployment Outside the Prior Stent.
An operator can be unaware that the guide wire has accidentally advanced into space outside the previous stent, which can result in deformation of the previous stent when a new stent is deployed outside the prior stent. We herein have reported a case of accidental guide wire advancement into a previously dissected lumen of right coronary artery (RCA), resulting in a new stent deploying outside the prior stent, resulting in deformity of the prior stent. Thrombus and friable atheromatous plaques dislodged and migrated to occlude distal RCA when attempting to restore the proximal luminal diameter by balloon inflation, resulting in profound shock with asystole. IVUS was successful in identifying the cause, and the thrombus was removed successfully by manual aspiration. Due to the poor endothelization of a recent stenting, clinicians should be particularly careful of possible wire advancing outside the stent structure, which can result in prominent thrombus or atheromatous debris occluding the distal vessel, and IVUS may be useful in confirming the cause of no-reflow.
Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University, Taipei;
Chih-Hung
CH
Lai
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei; ; School of Medicine, National Yang-Ming University, Taipei;
Shih-Hsien
SH
Sung
Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University, Taipei;
Wen-Lieng
WL
Lee
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University; ; Healthy Aging Research Center, Chang Gung University, Taoyuan;
Yu-Hsiang
YH
Juan
School of Medicine, National Yang-Ming University, Taipei; ; Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Szu-Ling
SL
Chang
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei; ; School of Medicine, National Yang-Ming University, Taipei;
Tse-Min
TM
Lu
Coronary dissection; Intravascular ultrasound; No reflow; Recent myocardial infarction; Stent deformation