Korean Circ J.  2010 Aug;40(8):405-409. 10.4070/kcj.2010.40.8.405.

A Novel Technique for Retrieval of a Drug-Eluting Stent After Catheter Break and Stent Loss

• Wani SP
• Rha SW
• Park JY
• Poddar KL
• Wang L
• Ramasamy S
• Moon JM
• Kim JB
• Ryu SR
• Shin SY
• Choi UJ
• Choi CU
• Lim HE
• Kim JW
• Kim EJ
• Park CG
• Seo HS
• Oh DJ

• KMID: 2145533
• DOI: http://doi.org/10.4070/kcj.2010.40.8.405

Abstract

Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.

Keyword

Angioplasty; Transluminal; Percataneous coronary

MeSH Terms

Angioplasty
Cardiac Catheterization
Cardiac Catheters
Catheters
Dimaprit
Drug-Eluting Stents
Emergencies
Humans
Stents
Thoracic Surgery
Dimaprit

Figure

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  Fig. 1 A: a baseline coronary angiogram in the right anterior oblique view showing the culprit lesion in the mid LAD (arrow). B: predilation was done with a 2.0×15 mm balloon. C: a 2.5×33 mm Taxus stent (arrow) could not cross the culprit lesion in the mid LAD using the 'anchor balloon technique' in the diagonal branch under good guiding catheter support. D: a loop snare (arrow) was then used to grab the broken end of the stent catheter in the guide but it failed to grab it. LAD: left anterior descending artery.

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  Fig. 2 A 3.0×8 mm semi-compliant balloon (arrow) was inflated to a high pressure (14 atm) in the guide catheter in order to grab the entire assembly (A). B and C show the entire assembly being pulled out at the aortic and sheath levels respectively. After successful rewiring into the second lost unexpanded stent (arrow) in the mid LAD culprit lesion, a 1.5×15 mm balloon was crossed distally over the second lost stent to retrieve it (D).

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  Fig. 3 A simple balloon technique using a 1.5×15 mm balloon distal to the unexpanded stent (Taxus 2.5×16 mm) failed to retrieve it and the stent was partially deployed (arrow, A). The underexpanded lost stent was completely deployed over the proximal LAD using a larger 2.5×20 mm balloon (B). The two 2.75 mm Taxus stents were successfully deployed distal to the lost stent (C) to give an excellent final result (D).

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