J Lipid Atheroscler.  2016 Jun;5(1):87-92. 10.12997/jla.2016.5.1.87.

Re-mobilization of Lost Coronary Stent From the Axillary Artery to the Femoral Artery

• Lee JS
• Kim HL
• Seo JB
• Lim WH
• Kang EG
• Chung WY
• Kim SH
• Jo ZH
• Kim MA

• KMID: 2328841
• DOI: http://doi.org/10.12997/jla.2016.5.1.87

Abstract

Stent migration and loss are rare but can be devastating complications during percutaneous coronary intervention (PCI) for coronary artery disease. We report a unique case of wandering stent from the right coronary artery to the femoral artery via the axillary artery. Initially, the stent was stripped from the delivery catheter and embolized to axillary artery during emergent PCI. An intra-aortic balloon pump might have forced retrograde movement of the stent to axillary artery which have subsequently remobilized to the femoral artery. After stabilization, the stent was successfully removed by a percutaneous approach using a snare. Immediate retrieval of wandering stent is recommended for the prevention of secondary embolization.

Keyword

Complications; Drug-Eluting Stents; Embolism; Percutaneous coronary intervention

MeSH Terms

Axillary Artery*
Catheters
Coronary Artery Disease
Coronary Vessels
Drug-Eluting Stents
Embolism
Femoral Artery*
Percutaneous Coronary Intervention
SNARE Proteins
Stents*
SNARE Proteins

Figure

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  Fig. 1 Chest X-ray and electrocardiogram of our patient at the time of emergency department visit. (A) Chest X-ray shows bilateral haziness suggestive of pulmonary edema, (B) Electrocardiogram reveals sinus tachycardia with ST segment depressions in V5-6, II, III, and aVF leads.

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  Fig. 2 Coronary angiographic findings and PCI procedures. (A) An occluded proximal LAD (arrow) and moderate-degree stenosis of the LCX, (B) Multiple severe stenosis of RCA, (C) Successful LAD revascularization with a drug-eluting stent (arrow heads) with the IABP support (arrow), (D) Successful distal RCA revascularization with a drug-eluting stent (arrow heads), (E) Migrated coronary stent to the axilla (arrow), (F) Complete revascularization of the RCA. PCI; percutaneous coronary intervention, LAD; left anterior descending artery, LCX; left circumflex artery, RCA; right coronary artery, IABP; intra-aortic balloon pump, Scap; scapula, Hum; humerus.

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  Fig. 3 Tracking the lost coronary stent. (A) Computed tomography angiography of the upper extremities shows no evidence of the lost stent, (B) Fluoroscopic exploration shows the lost stent in the right superficial femoral artery (arrow).

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  Fig. 4 Retrieval of the lost coronary stent. (A) The stent (arrow) was caught by a snare device, and (B) successfully retrieved stent by using the snare.

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