Kosin Med J.  2013 Jun;28(1):55-60. 10.7180/kmj.2013.28.1.55.

Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon

• Kim SY
• Han SH
• Kim KH
• Kim MH
• Park JS

• KMID: 2308512
• DOI: http://doi.org/10.7180/kmj.2013.28.1.55

Abstract

Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.

Keyword

Complication; Coronary artery; Intervention; Stent

MeSH Terms

Coronary Vessels
Stents

Figure

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  Fig. 1. Electrocardiogram after coronary artery dissection and acute total occlusion of left circumflex coronary artery showed ST segment elevation and T wave inversion in V4-V6, I, and aVL leads.

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  Fig. 2. (A) Dislodged stent (arrow) was remained in proximal LCX. (B) Magnified view of the dislodged stent of 2.75 X 24 mm in size (arrow). (C) Coronary angiography showed coronary artery dissection and total occlusion of proximal LCX. (D) Magnified view of the dislodged stent. A floppy tipped guide wire was inserted to the lumen of dislodged stent (within arrowheads). (E) However, the guide wire entered to the false lumen of distal LCX formed by dissecting intimal flap. (F) Another guide wire was inserted and two guide wires were advanced alternately by parallel wire technique. Finally, a guide wire found the true lumen of distal LCX. LCX: left circumflex coronary artery.

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  Fig. 3. (A) A guide wire in false lumen was reinserted to the true lumen (B) A small balloon was positioned within the dislodged stent and inflated. (C) Partially expanded dislodged stent was fully expanded by a balloon with larger diameter. (D) Coronary angiography after direct expansion of the dislodged stent showed partial restoration of distal LCX flow. (E) A overlapping stent of 2.5 X 32 mm in size was implanted to cover coronary artery dissection. (F) Distal LCX flow was fully recovered after coronary artery intervention. LCX: left circumflex coronary artery.

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