Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.

BackgroundThe prophylactic use of temporary pacemaker during coronary intervention has been markedly decreased since 1980's. There is, however, few systematic report focusing on right coronary intervention in which temporary pacemaker would be most beneficial. Moreover, there has been marked development in coronary intervention recent years that risk and benefit of prophylactic pacemaker should be reconsidered. Method We performed right coronary artery intervention without prophylactic use of temporary pacemaker in 100 successive patients in Samsung Medical Center. Patients with previous AV block and rotational atherectomy cases were excluded. The incidence of all complications and changes of blood pressure as well as heart rate during coronary intervention were examined prospectively. Results The lesion type was B2 or C in 52% and intracoronary thrombus was found in 18% of patients. Nevertheless, there was neither life threatening bradycardia nor new onset arrhythmia in any patient during right coronary intervention. Conclusion These data suggest that omission of prophylactic use of temporary pacemaker may be safe in right coronary intervention only if excluding previous patients with high degree atrioventricular block and rotational atherectomy cases. This approach may reduce procedure time and cost as well as pacemaker-associated complications.

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Background and ObjectivesPrevious studies have shown a high restenosis rate after balloon angioplasty for diffuse in-stent restenosis. Debulking strategy has been expected to be helpful to reduce the restenosis rate. This study evaluated the safety and long-term clinical event rate after excimer laser coronary angioplasty ELCA and adjunctive balloon angioplasty for in-stent restenosis. Materials and Method We included 29 in-stent restenotic lesions treated in 28 patients 18 men, 10 women, mean age 60 2 years admitted to Samsung Medical Center between June 1997 and August 1998. Quantitative coronary angiography was performed and clinical characteristics, acute complications, 30-day and 8-month major cardiac adverse event rate was analyzed. Results Initial success rate was 97%. We stopped the ELCA procedure in one lesion located in the proximal left anterior descending artery due to bradycardia and hypotension. In the 28 lesions successfully treated with ELCA and adjunctive balloon angioplasty, the minimal luminal diameter increased from 0.7 0.1 mm before ELCA to 1.9 0.1 mm after ELCA and to 2.7 0.1 mm after adjunctive balloon angioplasty p .0001 . The acute luminal gain after ELCA was 60%. The diameter stenosis decreased from 75 2% before ELCA to 36 2% after ELCA and to 15 2% after adjunctive balloon angioplasty p .0001 . There was no in-hospital death, Q wave acute myocardial infarction AMI , emergency coronary artery bypass graft CABG , but non-Q AMI was noted in 1 case 3% . During the followed-up period of 8 months, there were 1 death 4% due to congestive heart failure, 1 nonQ-AMI 4% and 7 target lesion revascularization 26% among the successfully treated 27 patients, but there was no CABG, Q-AMI. Combined event rate at the 8-month follow-up was 33% and target lesion revascularization rate at 8-month follow-up was 26%. Conclusion The ELCA and adjunctive balloon angioplasty seems to be safe and effective for the treatment of in-stent restenosis. A prospective randomized trial comparing ELCA versus other ablative technique is required. Korean Circulation J 1999 ; 29 9 : 891-897