Caught up, then pushed down: the tribulations of one underexpanded coronary stent

Abstract

We report a case of an incidentally fished coronary stent through a filter-based embolic protection device. This device was successfully replaced in its initial location by pushing a balloon passing between the struts of the stent. This case report underlines the possibility of fishing an underexpanded coronary stent by a distal protection device.Key words: complication; stent underexpansion; stent retrieval; embolisation; embolic protection device Case reportA 67-year-old white male was admitted with acute coronary syndrome without ST segment elevation. He was medically treated for an anterior myocardial infarction 20 years prior to admission. He complained of typical chest pain 2 hours before admission but had been asymptomatic since that time. His ECG displayed the scar of an anterior myocardial infarction. His known cardiovascular risk factors were diabetes mellitus, dyslipidaemia, and smoking cigarettes (40 packs/year).He underwent coronary angiography ( fig. 1), which revealed a chronic occlusion of the left anterior descending artery (LAD, arrow) and a high-grade stenosis of the circumflex artery. The new lesion of the circumflex artery was treated and percutaneous coronary intervention was undertaken. In order to limit embolism from thrombotic material, the distal vessel was protected with a 4-mm Angiogard ® (Cordis, J&J Corps) distal protection system. The lesion was passed through the filter and treated by direct stent implantation using a 3.5/15-mm everolimus-eluting stent (Xience