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Journal of Public Health Policy and Planning | Volume 3
April 08-09, 2019 | Zurich, Switzerland
Health Care and Neuroscience
International Conference on
Successful management of dislodged stent in distal leŌ main: A case report
Mirwias Amiri, KhaƟra Zaheen, Razmi Rahman
Amiri Medical complex, Afghanistan
Introduction:
Stent dislodgement in the coronary
arteries during percutaneous coronary intervention
is a rare but potentially fatal complication. The
incidence of SD is reported 0.9 to 8.3%. Factors that
increases chance of stent entrapment during PCI
is tortuosity of coronary arteries, calcified lesions,
passage through a previous deployed stents, and
other common causes include poor support of the
guiding catheter, sharp angle proximal to the lesion,
as well as use of longer stents
Many different retrieval techniques of dislodged
stents have previously been reported which include
the use of balloon catheters, basket devices, loop
snares, twisted wires, etc., with a high success
rate in emergency cases when time is crucial and
because percutaneous retrieval is a time-consuming
procedure, the crushing of an entrapped and
dislodged stent against the wall has been proposed
as alternative option. And lastly the stent-crush
exclusion technique, whereby a second stent is used
to crush the detached stent along the wall of the
vessel. We report a case of stent dislodgment during
PCI to ostial circumflex coronary artery with more
sharp angle and a previously deployed stent in left
main coronary artery.
Case report:
A 69-year-old male patient was
admitted to our hospital with the symptoms of
effort angina for last 3 months. He was ex-smoker
and non diabetic, and reported previous treatment
for high blood pressure and dyslipidaemia, he had
underwent coronary angioplasty and stenting to
left main to LAD and to RCA in another center
abroad 11 months back. An electrocardiogram
at admittance showed the sinus rhythm with no
specific ST segment and T-wave changes. Physical
examination showed arterial blood pressure 124/65
mmHg and a pulse rate of 63bpm. Transthoracic
echocardiography revealed no regional wall motion
abnormality with left ventricular ejection fraction
60% and grade I LV diastolic dysfunction. In view
of his exertional anginal symptoms despite optimal
medical anti-anginal treatment, he was planned for
check coronary angiogram. His coronary angiogram
revealed patent stent ( left main to left anterior
descending coronary artery, patent RCA stent),
whereas a severely ostial disease of non dominant
but large size circumflex coronary artery (CX),
and the right coronary artery (RCA) were without
significant disease. Left coronary system was
engagedwith JL 4–7 Fr guiding catheter and coronary
wire Fielder FC was advanced through the ostial LCX
lesion to distal segment. Several sequential balloon
predilatations (low profile balloon 1.1 x 10mm at
18atmosphere and Sprinter Legend 2.0 x 10 mm at
14 atmosphere) in the Left main to ostial LCX done
with TIMI-III flow, while trying to cross the stent 2.5
x 12mm DES through the previously deployed left
main to LAD stent with a sharp angle between left
main and LCX and tortuous proximal segment of
LCX, stent dislodged in the bifurcation of LM to LCX.
The patient compained on intense chest pain and
suddenly developed severe bradycardia (30 beats
per minute) with a drop in blood pressure to 60/40
mmHg. The flow in LCX was disturbed but there was
TIMI-III flow in LAD, As we could not pull back the
stent which was stucked with the previously left
main stent and in sharp angle of ostial LCX, and on
the other hand we lose the guide wire in the target
vessel, we re-wired the lesion and decided to crush