Role of Intravascular Ultrasound in Managing a Rare Case of Delayed Stent Deformity

J INVASIVE CARDIOL 2020;32(4):E97.

Key words: cardiac imaging, stent deformity, stent-in-stent implantation

A 62-year-old male with a history of previous mid left anterior descending (LAD) percutaneous coronary intervention (PCI) in 2012 presented to an outside facility with ongoing precordial chest discomfort, which had been worsening in the past 2 hours and was associated with shortness of breath. Twelve-lead electrocardiography (ECG)demonstrated sinus rhythm with precordial ST depressions, and troponin T was elevated. 

The patient was taken urgently to the catheterization laboratory secondary to ongoing chest discomfort. He was found to have an occluded mid LAD stent (Figure 1A) with TIMI 0 flow beyond the mid LAD. PCI of the mid LAD stent thrombosis was attempted with successful restoration of TIMI 3 flow, but the previous mid LAD stent could not be adequately dilated, and there was residual 70% angiographic stenosis (Figure 1B). Therefore, he was transferred to our facility for possible in-stent laser or rotational atherectomy for possible in-stent restenosis management.

The patient was brought to the catheterization lab a few days later for a repeat procedure. Intravascular ultrasound (IVUS) of the mid LAD demonstrated stent deformity (Figure 1C) with crushing of the proximal to mid stent, which resulted in lumen narrowing. There was no in-stent restenosis; most likely, the deformity resulted from the wire passing under the stent struts and exiting through the lumen at the distal portion, followed by balloon angioplasty.

We attempted to dilate the lumen within the crushed stent, but were unsuccessful even after laser atherectomy. At this point, we opted to place a new stent within the deformed old stent. After serial dilation at high pressures with a non-compliant balloon, we were able to expand the new stent with excellent angiographic and IVUS results (Figure 1D).

Delayed stent deformity is a very rare complication, and IVUS guided its diagnosis and management.

From King’s College Hospital, London, 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. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted July 1, 2019.

Address for correspondence: Pallavi Satuluri, MBBS, University of Nevada, Las Vegas, Las Vegas, NV. pallavi.satuluri@unlv.edu