Chonnam Med J.  2013 Dec;49(3):129-132. 10.4068/cmj.2013.49.3.129.

Percutaneous Treatment of an Injured Coronary Stent Using the Looping Wire Technique

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea. medorche@jbnu.ac.kr

Abstract

Drug-eluting stent implantation is an effective treatment for coronary artery disease, yet unexpected serious complications during stent implantation are possible. A 70-year-old man with unstable angina presented with a left main bifurcation lesion. Two drug-eluting stents were successfully deployed at the left main bifurcation lesion by the mini-crush technique under intravascular ultrasound guidance. However, after removal of the wire and intravascular ultrasound catheter, the stent of the proximal left circumflex artery was damaged and shortened at the distal edge. We used a looping wire technique to cross the injured stent and we successfully re-dilated the damaged portion of the stent. Finally, we deployed an additional drug-eluting stent at the left circumflex artery over the damaged stent. Our case illustrates the importance of gentle handling of devices during coronary intervention. Furthermore, interventionists should keep in mind the role of intravascular ultrasound when treating this kind of serious complication.

Keyword

Drug-eluting Stents; Complication; Angioplasty

MeSH Terms

Aged
Angina, Unstable
Angioplasty
Arteries
Catheters
Coronary Artery Disease
Drug-Eluting Stents
Humans
Stents*
Ultrasonography

Figure

  • FIG. 1 Coronary angiography was done after implantation of two stents. After removal of the IVUS catheter, there was distal edge damage and shortening of the EES at the LCX in both the RAO caudal (A, black arrow) and spider view (B). IVUS: intravascular ultrasound, EES: everolimus-eluting stent, LCX: left circumflex artery, RAO: right anterior oblique.

  • FIG. 2 We performed a looping wire technique using a 0.014'' hi-torque Balance Middleweight universal coronary guide wire (Abbott Vascular, Santa Clara, CA, USA) to cross the damaged stent and we successfully re-dilated the damaged portion (A). The final coronary angiography showed good flow with dye staining at the LCX (B). LCX: left circumflex artery.

  • FIG. 3 Coronary angiography after EES implantation (A): IVUS finding in each point. IVUS using a pull-back system from the distal coronary artery showed good expansion and the three well-apposed EESs at the distal left main (E), the bifurcation of the left main (D), and the proximal LCX (C), with the exception of the partially crushed EES (B, white arrow). IVUS: intravascular ultrasound, EES: everolimus-eluting stent, LCX: left circumflex artery.


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