Successful Coronary Stent Retrieval From a Pedal Artery

Abstract

The purpose of this article is to report complications from a coronary drug-eluting stent lost in the peripheral circulation. We report the case of successful retrieval of a sirolimus coronary stent from a pedal artery in a young patient who underwent coronary angiography for previous anterior myocardial infarction. Recognition of stent embolization requires adequate removal of the device to avoid unwelcome clinical sequelae.The occurrence of stent loss during percutaneous coronary interventions appears to have decreased in recent years, probably due to improvements in equipment design and to the almost universal use of premounted stents. Unfortunately, dislodgement of a stent during its deployment is still an unwelcome complication in coronary stenting procedures and has been reported to occur in 1% to 8.4% of cases [1]. This event may result in coronary, cerebral, or peripheral embolization with potentially adverse sequelae [2,3]. Improved deployment strategies, including new stent designs, are required to decrease procedural risk. We report the case of successful coronary stent retrieval in a patient in whom a drug-eluting stent was dislodged from a balloon catheter to the pedal artery after failed intracoronary delivery. Case ReportA 47-year-old man with coronary artery disease was admitted to our hospital because of dyspnoea occurring 2 months after anterior myocardial infarction. Physical examination was normal, whereas the electrocardiogram showed sinus rhythm and signs of previous anteroseptal myocardial infarction. Laboratory parameters were within normal limits.Preoperative transthoracic echocardiography showed fairly decreased left ventricular function (ejection fraction 45%) associated with apical and distal septum wall akinesia and evidence of a thrombus stratification in the apex.Coronary angiography was performed using a standard right femoral approach with the placement of a 6F short sheath. Selective left coronary angiography showed twovessel disease, with evidence of spontaneous dissection in the middle segment of the left anterior descending coronary artery (LAD) and severe narrowing superimposed to an ulcerated plaque in the proximal segment of the right coronary artery (RCA). After coronary revascularization of the RCA, direct stenting of the lesion in the middle tract of the LAD was attempted with a 3.5 · 33-mm Cypher (Cordis Europa, Roden, The Netherlands) stent. During advancement of the stent, the device became entrapped, making it impossible to retrieve the stent in the guiding catheter because of the partial enlargement of its distal struts. Therefore, the guiding catheter and the stent-loaded balloon were carefully brought into the descending aorta as one unit to avoid embolization in the cerebral circulation. Unfortunately, during this manoeuvre the stent was dislodged from

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“…Unfortunately, the stent was lost and migrated with the blood stream to the left popliteal artery. There are many reports of stent embolization and successfully percutaneous retrieval from peripheral vessels, such as from renal artery, pedal artery or abdominal aorta [7][8][9]. However, in our case the non-surgical retrieval from the left popliteal artery was impossible, because the stent was already damaged and it has been migrated far enough below the aortoiliac bifurcation.…”