nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”nmp-109Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS OF LITERATUREСОВРЕМЕННЫЕ ПОДХОДЫ К ПРОФИЛАКТИКЕ, ОЦЕНКЕ И ЛЕЧЕНИЮ ОСЛОЖНЕНИЙ ЭНДОВАСКУЛЯРНЫХ ВМЕШАТЕЛЬСТВ НА КОРОНАРНЫХ АРТЕРИЯХ. ЧАСТЬ III. ПОТЕРЯ И МИГРАЦИЯ КОРОНАРНОГО СТЕНТА ПРИ ЭНДОВАСКУЛЯРНЫХ ВМЕШАТЕЛЬСТВАХ (ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЕ НАБЛЮДЕНИЯ)MODERN APPROACHES TO PREVENTION, EVALUATION AND TREATMENT OF COMPLICATIONS ASSOCIATED WITH ENDOVASCULAR CORONARY ARTERY INTERVENTIONS. PART III. LOSS AND MIGRATION OF CORONARY STENTS DURING ENDOVASCULAR INTERVENTIONS (REVIEW OF LITERATURE AND GENUINE CLINICAL OBSERVATIONS)ПрозоровС. А.ProzorovS. A.

д.м.н., ведущий научный сотрудник отделения рентгенохирургических методов диагностики и лечения

surgeonserge@mail.ruНИИ скорой помощи им. Н.В. Склифосовского ДЗ г. Москвы, МоскваРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department, MoscowRussian Federation201427032016041924Copyright © Прозоров С.А., 20162016Прозоров С.А.Prozorov S.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/109ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Анализ частоты, предикторов, подходов к лечению потери и миграции стента во время коронарных вмешательств.

МАТЕРИАЛ И МЕТОДЫ

МАТЕРИАЛ И МЕТОДЫ. Смещение стента произошло у 4 больных (3 мужчин и 1 женщина в возрасте 45–70 лет), что составило 0,13% от 3081 коронарного вмешательства с января 2010 г. по декабрь 2013 г. В 3 случаях вмешательства выполняли при остром состоянии.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. У 3 больных была предпринята попытка стентирования огибающей артерии, а в одном случае — передней межжелудочковой артерии. У 2 пациентов нераскрытый стент не был удален из коронарного русла, у одного стент был низведен и удален из бедренной артерии при артериотомии и еще у одного больного после низведения в терминальный отдел аорты визуализация стента была утрачена.

ВЫВОДЫ

ВЫВОДЫ. Предикторами потери и миграции коронарного стента становятся: острое состояние, большой угол отхождения сосуда и его извитость, кальциноз. Для извлечения стента используют различные методы: обвивание стентов двумя проводниками; проведение через стент баллонного катетера, его раздувание и удаление стента; извлечение с помощью различных петель и щипцов. При невозможности удаления стента рекомендуется применение «crush»-метода. При смещении стента в дистальное русло дальнейших осложнений, как правило, не наступает. 

THE PURPOSE OF THE STUDY

THE PURPOSE OF THE STUDY. The purpose is an analysis of the frequency, predictors, and approaches of treatment for loss and migration of the stent during coronary interventions.

MATERIAL AND METHODS

MATERIAL AND METHODS. Stent migration occurred in 4 patients (3 men and 1 woman aged 45–70 years), which accounted for 0.13% of 3081 cases of coronary intervention from January 2010 to December 2013. In 3 cases, interventions were performed in acute condition.

RESULTS

RESULTS. In 3 patients, there was an attempt to stent the circumflex artery and in one case – the anterior interventricular artery. In 2 patients, the undeployed stent was not retreived from the coronary bed, in 1 patient, the stent was advanced down and removed from the femoral artery during arteriotomy, and in 1 patient, visualization of the stent was lost after being advanced down to the terminal branches of aorta.

CONCLUSIONS

CONCLUSIONS. Predictors of loss and migration of coronary stents are: acute condition, a large divergence angle of a vessel and its tortuosity, calcification. Different methods are used to remove the stent: wrapping two guide wires around the stent; advance of a balloon catheter through the stent, its expansion and removal of the stent; extraction using various loops and forceps. When the removal of the stent is impossible, the «crush» method may be used. By moving the stent into the distal bed further complications usually does not occur. 

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The authors declare that there are no conflicts of interest present.