Unintentional Extraction of a Deployed Coronary Stent Due to Microcatheter Fracture

Percutaneous coronary intervention (PCI) was performed on a patient with previous PCI to the left anterior descending (LAD) artery/first diagonal (D1) bifurcation and known occlusive in-stent restenosis of the D1 stent (Figure 1). A Turnpike Spiral (TS) (Teleflex) and Pilot 200 (Abbott Vascular) were used to wire the occluded D1. However, the TS would not cross the D1 ostium. The TS was trapped out, and the D1 ostium was crossed with a 1.5 x 20 mm balloon and dilated. The TS was trapped in and a Sion wire (Asahi Intecc) took 2 branches distally, confirming true lumen position. The D1 was dilated, resulting in Thrombolysis in Myocardial Infarction (TIMI) 3 flow and easy balloon transit.

An intravascular ultrasound demonstrated the D1 wire in true lumen with the previously implanted D1 stent squashed into the vessel wall. An Orsiro stent (Biotronik) was passed into the D1 and deployed. The balloon and wire were removed and the stent was crushed with a non-compliant balloon. We attempted to recross the D1 stent but a 1.5 x 15 mm balloon would not cross. The TS was used with a Sion blue wire to recross the diagonal stent but the TS would not cross, despite LAD anchor balloon support.

Torquing of the TS led to disruption of the distal tip, which detached from the TS body, while remaining on the wire. The TS and wire were both removed. Upon inspection, the deployed D1 stent was also extracted. Due to a dissection plane and TIMI 3 flow in the D1, we decided not to re-wire.

A follow-up angiogram at 6 weeks demonstrated patent LAD stents and a 90% ostial D1 lesion. Successful PCI was performed to the D1 with an excellent final angiographic result. To our knowledge, this is the first reported case of unintentional removal of a deployed stent due to a fracture of a microcatheter tip.