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A Novel, Simple, and Safe Technique for Retrieving a Crushed Stent From the Coronary Artery: Balloon-Assisted Stent Retraction
J INVASIVE CARDIOL 2017;29(12):E203-E204.
Key words: cardiac imaging, complications, crushed stent
A 72-year-old gentleman had percutaneous coronary intervention to a chronic total occlusion of the right coronay artery (RCA) with successful antegrade wire crossing using Amplatz left 1 through right radial artery. A 3.0 x 38 mm Promus Premier stent (Boston Scientific) was positioned, but failed to cross the entire lesion due to a calcified distal plaque.
An attempt to push the stent further with uncontrolled guide-catheter movement led to stripping the stent off the balloon and crushing its proximal half (the “concertina” effect), which was stuck in the vessel wall due to the jagged edges (Figure 1A). All attempts to pull the stent back into the guide failed. At this stage, a small 0.85 mm balloon mounted on a second wire was placed just beside the crushed stent and inflated at low pressure to free its edges. We then used a novel, simple technique to extract the crushed stent safely out of the coronary whereby a 2.5 mm balloon was used to dilate the mouth of the guide to stretch this open wide (Figure 1B). Subsequently, the jagged proximal edge of the stent was successfully pulled into the guide (Figure 1C) and the entire system (guide, stent, and wire) was then withdrawn backward (Video 1). At the radial sheath, the bulky stent got stuck again and the distal end of the radial sheath was dilated with the 2.5 mm balloon flaring it up (Figures 2A and 2B; Video 2). Finally, the stent was completely retrieved (Figure 3A; Video 3) and a final angiogram showed no vascular damage.
Various percutaneous methods have been described for the retrieval of damaged stents, including the 2-wire entanglement technique, distal filter-wire entrapment technique, and snaring.1,2 However, these methods may be complex or time consuming, carry a risk of stent embolization or vascular damage, and are not always successful.
The stent was still mounted on its balloon in the presented case, but we felt that deploying such a distorted stent with multiple proximal metallic layers (Figure 3B) would certainly increase the risk of in-stent restenosis/thrombosis. Similarly, just pulling back this stent would have resulted in significant brachial/radial damage and risk of stent embolization if its jagged edges were not contained safely inside the guide/sheath.
By dilating the distal ends of the guide and the sheath with the use of a compliant balloon that is slightly larger than their respective inner diameters to flare the distal ends, balloon-assisted stent retraction can be a simple and safe way to retrieve a damaged stent.
References
1. Eisenhauer AC, Piemonte TC, Gossman DE, et al. Extraction of fully deployed stents. Catheter Cardiovasc Diagn. 1996;38:393-401.
2. Paulus BM, Fischell TA. Retrieval devices and techniques for the extraction of intravascular foreign bodies in the coronary arteries. J Interv Cardiol. 2010;23:271-276.
From the Cardiology Department, Blackpool Teaching Hospital, Blackpool, United Kingdom.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted May 24, 2017.
Address for correspondence: Hesham Abdelaziz, MRCP (Lond), PhD, Cardiology Department, Blackpool Teaching Hospital, Blackpool, United Kingdom. Email: heshamkabdelaziz@gmail.com
