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)
Abstract
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. 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. 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. 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.
About the Author
S. A. Prozorov
N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department, Moscow
Russian Federation
Russian Federation
References
1. Eggebrecht H., Haude M., von Birgelen C., et al. Nonsurgical retrieval of embolized coronary stents // Catheter Cardiovasc. Interv. – 2000. – Vol. 51, N. 4. – P. 432–440.
2. Ngow H. Stent dislodgement in left anterior descending coronary artery and successful deployment with two parallel wires and a small balloon // Kardiol. Pol. – 2009. – Vol. 67, N. 9. – P. 1040–1042.
3. Brilakis E.S., Best P.J., Elesber A.A., et al. Incidence, retrieval methods, and outcomes of stent loss during percutaneous coronaryintervention: a large single-center experience // Catheter Cardiovasc. Interv. – 2005. – Vol. 66, N. 3. – P. 333–340.
4. Colkesen A.Y., Baltali M., Acil T., et al. Coronary and systemic stent embolization during percutaneous coronary interventions: a single center experience // Int. Heart J. – 2007. – Vol. 48, N. 2. – P. 129–136.
5. Dunning D.W., Kahn J.K., O’Neill W.W. The long-term consequences of lost intracoronary stents // J. Interv. Cardiol. – 2002. – Vol. 15, N. 5. – P. 345–348.
6. Nikolsky E., Gruberg L., Pechersky S. Stent deployment failure: reasons, implications, and short- and long-term outcomes // Catheter Cardiovasc. Interv. – 2003. – Vol. 59, N. 3. – P. 324–328.
7. Alfonso F., Martinez D., Hernandez R., et al. Stent embolization during intracoronary stenting // Am. J. Cardiol. – 1996. – Vol. 78, N. 7. – P. 833– 835.
8. Elsner M., Peifer A., Kasper W. Intracoronary loss of balloon-mounted stents: successful retrieval with a 2 mm-”Microsnare”-device // Cathet. Cardiovasc. Diagn. – 1996. – Vol. 39, N. 3. – P. 271–276.
9. Laarman G., Muthusamy N.S., Swart H., et al. Direct coronary stent implantation: safety, feasibility, and predictors of success of the strategy of direct coronary stent implantation // Catheter Cardiovasc. Interv. – 2001. – Vol. 52, N. 4. – P. 443–448.
10. Bedossa M., Breton H.L., Leclercq C., et al. Loss of a stent in the left main coronary artery and secondary migration into the left circumflex artery needing surgical extraction. Apropos of a case // Arch. Mal. Coeur Vaiss. – 1996. – Vol. 89, N. 12. – P. 1677–1680.
11. Y Imaz H., Belgi A., Demir I., et al. Successful transcatheter retrieval of an embolized stent from the left ventricle // J. Invasive Cardiol. – 2002. – Vol. 14, N. 8. – P. 466–468.
12. Berder V., Bedossa M., Gras D., et al. Retrieval of a lost coronary stent from the descending aorta using a PTCA balloon and biopsyforceps // Cathet. Cardiovasc. Diagn. – 1993. – Vol. 28, N. 4. – P. 351–353.
13. Douard H., Besse P., Broustet J.P. Successful retrieval of a lost coronary stent from the descending aorta using a loop basketintravascular retriever set // Cathet. Cardiovasc. Diagn. – 1998. – Vol. 44, N. 2. – P. 224–226.
14. Eeckhout E., Stauffer J.C., Goy J.J. Retrieval of a migrated coronary stent by means of an alligator forceps catheter // Cathet. Cardiovasc. Diagn. – 1993. – Vol. 30, N. 2. – P. 166–168.
15. Jang J.H., Woo S.I., Yang D.H., et al. Successful coronary stent retrieval from the ascending aorta using a gooseneck snare kit // Korean J. Intern. Med. – 2013. – Vol. 28, N. 4. – P. 481–485.
16. Li C., Yang Z., Cao K. Retrieval of dislodged coronary stent from left renal artery by gooseneck snare // J. Biomed. Res. – 2010. – Vol. 24, N. 6. – P. 479–482.
17. Juszkat R., Dziarmaga M., Zabicki B., Bychowiec B. Successful coronary stent retrieval from the renal artery // Cardiol. J. – 2007. – Vol. 14, N. 1. – P. 87–90.
18. Cishek M.B., Laslett L., Gershony G. Balloon catheter retrieval of dislodged coronary artery stents: a novel technique // Cathet. Cardiovasc. Diagn. – 1995. – Vol. 34, N. 4. – P. 350–352.
19. Kammler J., Leisch F., Kerschner K., et al. Long-term follow-up in patients with lost coronary stents during interventional procedures // Am. J. Cardiol. – 2006. – Vol. 98, N. 3. – P. 367–369.
20. Meisel S.R., DiLeo J., Rajakaruna M., et al. A technique to retrieve stents dislodged in the coronary artery followed by fixation in the iliac artery by means of balloon angioplasty and peripheral stent deployment // Catheter Cardiovasc. Interv. – 2000. – Vol. 49, N. 1. – P. 77–81.
21. Varvarovsky I., Matejka J. Unintended stent extraction from a coronary artery during bifurcation coronary angioplasty // J. Invasive Cardiol. – 2007. – Vol. 19, N. 11. – P. 496–499.
22. Yang D.H., Woo S.I., Kim D.H., et al. Two dislodged and crushed coronary stents: treatment of two simultaneously dislodged stents using crushing techniques // Korean J. Intern. Med. – 2013. – Vol. 28, N. 6. – P. 718– 723.
23. Rozenman Y., Burstein M., Hasin Y., Gotsman M.S. Retrieval of occluding unexpanded Palmaz-Schatz stent from a saphenous aorto-coronary vein graft // Cathet. Cardiovasc. Diagn. – 1995. – Vol. 34, N. 2. – P. 159– 161.
24. Bogart D.B., Jung S.C. Dislodged stent: a simple retrieval technique // Catheter Cardiovasc. Interv. – 1999. – Vol. 47, N. 3. – P. 323–324.
25. Veldhuijzen F.L., Bonnier H.J., Michels H.R., et al. Retrieval of undeployed stents from the right coronary artery: report of two cases // Cathet. Cardiovasc. Diagn. – 1993. – Vol. 30, N. 3. – P. 245–248.
26. Wong P.H. Retrieval of undeployed intracoronary Palmaz-Schatz stents // Cathet. Cardiovasc. Diagn. – 1995. – Vol. 35, N. 3. – P. 218–223.
27. Kim J.H., Jang W.J., Ahn K.J., et al. Successful retrieval of intravascular stent remnants with a combination of rotational atherectomy and a gooseneck snare // Korean Circ. J. – 2012. – Vol. 42, N. 7. – P. 492–496.
28. Wani S.P., Rha S.W., Park J.Y. Entrapment of a drug-eluting stent in left anterior descending artery and left main artery leading to a life-threatening complication // J. Invasive Cardiol. – 2010. – Vol. 22, N. 5.– E90–92.
29. Erez E., Herz I., Snir E., et al. Surgical removal of stent entrapped in proximal left coronary artery system // Ann. Thorac. Surg. – 1996. – Vol. 62, N. 3. – P. 884–885.
30. Gomes W.J., Palma J.H., Carvalho A.C., Buffolo E. Surgical retrieval of undeployed intracoronary stent without cardiopulmonary bypass // Eur. J. Cardiothorac. Surg. – 1997. – Vol. 12, N. 4. – P. 666–667.
Review
For citations:
Prozorov S.A. 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). Russian Sklifosovsky Journal "Emergency Medical Care". 2014;(4):19-24. (In Russ.)
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