Korean Circ J.  2012 Jul;42(7):492-496. 10.4070/kcj.2012.42.7.492.

Successful Retrieval of Intravascular Stent Remnants With a Combination of Rotational Atherectomy and a Gooseneck Snare

• Kim JH
• Jang WJ
• Ahn KJ
• Song YB
• Hahn JY
• Choi JH
• Choi SH
• Lee SH
• Gwon HC

• KMID: 2094122
• DOI: http://doi.org/10.4070/kcj.2012.42.7.492

Abstract

Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.

Keyword

Percutaneous transluminal coronary angioplasty; Stents; Migration; Rotational atherectomy

MeSH Terms

Angioplasty, Balloon, Coronary
Aorta
Atherectomy, Coronary
Catheters
Coronary Vessels
Percutaneous Coronary Intervention
SNARE Proteins
Stents
SNARE Proteins

Figure

• 

  Fig. 1 The comparison of the mid-left anterior descending artery pre-stenting and post-stenting. A: left coronary angiogram (anterior-posterior cranial view) showed a calcified tortuous bifurcation lesion at the mid-left anterior descending artery. B: left coronary angiogram (right anterior oblique cranial view) demonstrating a long type-B edge dissection at the distal part of the stent (arrows).

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  Fig. 2 The migrated stent in the aortic sinus. A part of it is in the aorta (thin arrow) and the rest inside the left anterior descending artery (thick arrow) with a connection to the thread of the stent strut that is unrolled and outstretched. A: angiographic anterior-posterior cranial view. B: fluoroscopic left anterior oblique cranial view.

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  Fig. 3 Fluoroscope photos to illustrate the porcedure in removal of the remnant stent. A: a part of the stent in the aortic sinus was captured by a 10-mm multisnare. B: grinding and curing out the stent strut by rotablator (thin arrow) with a 1.75 mm burr, and the remnant stent inside the left anterior descending artery (thick arrow). C: the stent captuted by the multisnare was released through the sheath in the right femoral artery.

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  Fig. 4 The removed stent. A: the stent strut was overstretched and extended. B: two stents tangled together.

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  Fig. 5 Intravascular ultrasonography image taken after the removal of the stent. A: the proximal edge of the stent: part of the stent strut is missing (white arrows for stent strut, black arrows for arterial wall without stent struts). B: the presence of severe dissection (white arrow) from the proximal stent edge to the distal left main artery.

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  Fig. 6 The final angiogram showed an acceptable result in the LAD. The dissection in the LAD distal to the stent was not treated, but Thrombolysis in Myocardial Infarction 3 flow maintained. LAD: left anterior descending artery.

Reference

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