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Page 54
Journal of Public Health Policy and Planning | Volume 3
April 08-09, 2019 | Zurich, Switzerland
Health Care and Neuroscience
International Conference on
the unexpanded dislodged stent against the wall
in the distal left main and ostio-proximal LCX with
2 x 10mm balloon inflating it up to 16atm, This
resulted in a rapid blood flow restoration in LCX
(TIMI-III), thought there was some plaque shifting
in the ostial LAD then crushed with a stent 2.5 x
12mm ( DES) at 14atm, with a good TIMI-III flow,
another coronary wire BMW was advanced in left
main to LAD and final kissing balloon done with 3.5
x 13mm non complaint balloon in left main to LAD
and 2x 10mm balloon in LCX at 12atm. Meanwhile
application of atropine and normal saline infusion
resulted in hemodynamic stabilization of the
patient. The final angiographic result was optimal
with uneventful later in hospital course. The patient
was discharged on day 3rd. A follow-up during the
next three months showed good patient health
with the absence of ischemic symptoms. Coronary
angiography was performed after three months
which showed patent all stents.
Discussion:
Stent entrapment and dislodgement
in the left main coronary artery is an extremely
rare but a serious and life threatening complication
which may cause hemodynamic instability,
intracoronary thrombosis, stent embolization,
myocardial infarction and eventually death. The
incidence of SD during PCI has been decreased,
from 8.3% twenty years ago to currently 0.02%.
According to the previous published literature data,
the most common cause of stent dislodgement
during PCI is attempt to deliver a stent though a
previously deployed stent and pull-back. In our
case, Probably, the most important causes of stent
loss were the previously deployed stent in left main
and sharp angle between the left main and LCX as
well as tortuosity of LCX. Hemodynamic state of
the patient after stent dislodgement is important
factor for its management technique as well as the
coronary flow in the vessel with entrapped and
unexpanded stent. In case of hemodynamically
unstable with compromisation of the coronary
flow after SD during PCI, as in this reported case, it
is crucial to promptly reestablish the coronary flow
and stabilize the hemodynamics first. Furthermore,
in such a case of hemodynamically unstable patient
sometimes trying to retrieve the dislodged stent
specially when the stent is entrapped in the angle of
left main with a previously deployed stent and left
circumflex, as in our case, can be more problematic
and life – threatening. So, in this particular situation
the only way to go further with the procedure
was to crush the dislodged stent with the balloon
and then with a stent against the wall of coronary
artery. However, this technique has not been widely
accepted for the left main and proximal LCX because
it may pose later an increased risk for both stent
thrombosis and restenosis due to excess metal layer.
In our case, none of the mentioned techniques for
retrieving a dislodged stent were possible, due to
presence of previously deployed left main stent
and the very sharp angle of ostial LCX, other than
this, there was possible risk of embolization of the
unexpanded stent in LAD and losing its flow which
further could deteriorate patients hemodynamics.
So, it was safer approach to crush the dislodged
stent with balloon and then with a stent.
Conclusion:
Stent dislodgment during percutaneous
coronary intervention can be successfully managed
with different methods. Our case demonstrated that
one of the safe and effective option for management
of hemodynamically unstable patient is balloon
crushing of entrapped and dislodged stent in the
distal left main and ostial left circumflex coronary
artery. In compare with the other recommended
stent retrieval techniques which is time consuming
in such emergency situation where establishing
coronary blood flow and stabilizing patient’s
hemodynamic is crucial. It should always be kept
in mind that the presence of previously deployed
stent and an angulated and tortuous segments of