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Stent loss in the radial artery - surgical vs. interventional approach - report of two cases.

Baszko A, Telec W, Naumowicz E, Siminiak T, Kałmucki P - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: The superficial location of the distal radial artery segment facilitates surgical cut-down with local anaesthesia.When dislodgement occurs in deeper segments of the radial artery, the benefits from cut-down seem to be less because the procedure might take more time and be more difficult - as in the presented case in which we decided to rewire and fully expand the stent in situ.Retrieval of the stent at all costs might have led to further complications; hence stent deployment may be a good alternative to retrieval in such cases.

View Article: PubMed Central - PubMed

Affiliation: 2 Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT
Stent loss during coronary angioplasty is a complication that can be managed in various manners; however, transradial access limits the options available. We describe two coronary interventions complicated by stent dislodgement, initially managed by pulling the stent back to the radial artery. Both stents were unwillingly lost on different levels in radial arteries. The first case was managed with a direct radial artery cut-down because distal location made it a quick and straightforward procedure. In the second case a partially deployed stent was lost in the proximal part of the radial artery. It was rewired, deployed, and post-dilated with a larger balloon. This enabled continuation of the procedure using the same access. Both cases were asymptomatic during 24 months of follow-up. It is crucial to avoid leaving artificial bodies in arteries supplying vital organs because stent-related thrombosis or stenosis may seriously compromise blood flow. Removing the stent via the introducer sheath should be considered the optimal treatment. Unfortunately it is common that a partially expanded stent will not pass through the sheath. The superficial location of the distal radial artery segment facilitates surgical cut-down with local anaesthesia. When dislodgement occurs in deeper segments of the radial artery, the benefits from cut-down seem to be less because the procedure might take more time and be more difficult - as in the presented case in which we decided to rewire and fully expand the stent in situ. Retrieval of the stent at all costs might have led to further complications; hence stent deployment may be a good alternative to retrieval in such cases.

No MeSH data available.


Related in: MedlinePlus

Stent pullback at the level of right subclavian artery
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Figure 0001: Stent pullback at the level of right subclavian artery

Mentions: The procedure of PCI of the RCA was attempted. A Whisper ES (Whisper ES, Abbott) guidewire was inserted and several predilations were performed using 2.0 × 20 mm and 2.5 × 20 mm angioplasty balloons (Sprinter Legend, Medtronic). The drug eluting stent did not cross the distal calcified lesion (Xience Prime 3.5 × 28 mm, Abbott). During the stent pullback to the guiding catheter it slipped out leaving an approximately 2–3 mm margin covering the distal part of the balloon. The stent could not be advanced again, and an attempt to remove it was made. In order to do so, the balloon was inflated to 6 atm to fixate the stent. The stent, along with the inflated balloon and catheter, were pulled back together into the sheath (Figures 1–2). As we could not get the stent into the sheath the entire assembly was removed en bloc, unfortunately leaving the stent in the radial artery in the wrist region. Light compression was applied to stop bleeding, and under X-ray the location of the stent was confirmed at the level of artery puncture.


Stent loss in the radial artery - surgical vs. interventional approach - report of two cases.

Baszko A, Telec W, Naumowicz E, Siminiak T, Kałmucki P - Postepy Kardiol Interwencyjnej (2015)

Stent pullback at the level of right subclavian artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372633&req=5

Figure 0001: Stent pullback at the level of right subclavian artery
Mentions: The procedure of PCI of the RCA was attempted. A Whisper ES (Whisper ES, Abbott) guidewire was inserted and several predilations were performed using 2.0 × 20 mm and 2.5 × 20 mm angioplasty balloons (Sprinter Legend, Medtronic). The drug eluting stent did not cross the distal calcified lesion (Xience Prime 3.5 × 28 mm, Abbott). During the stent pullback to the guiding catheter it slipped out leaving an approximately 2–3 mm margin covering the distal part of the balloon. The stent could not be advanced again, and an attempt to remove it was made. In order to do so, the balloon was inflated to 6 atm to fixate the stent. The stent, along with the inflated balloon and catheter, were pulled back together into the sheath (Figures 1–2). As we could not get the stent into the sheath the entire assembly was removed en bloc, unfortunately leaving the stent in the radial artery in the wrist region. Light compression was applied to stop bleeding, and under X-ray the location of the stent was confirmed at the level of artery puncture.

Bottom Line: The superficial location of the distal radial artery segment facilitates surgical cut-down with local anaesthesia.When dislodgement occurs in deeper segments of the radial artery, the benefits from cut-down seem to be less because the procedure might take more time and be more difficult - as in the presented case in which we decided to rewire and fully expand the stent in situ.Retrieval of the stent at all costs might have led to further complications; hence stent deployment may be a good alternative to retrieval in such cases.

View Article: PubMed Central - PubMed

Affiliation: 2 Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.

ABSTRACT
Stent loss during coronary angioplasty is a complication that can be managed in various manners; however, transradial access limits the options available. We describe two coronary interventions complicated by stent dislodgement, initially managed by pulling the stent back to the radial artery. Both stents were unwillingly lost on different levels in radial arteries. The first case was managed with a direct radial artery cut-down because distal location made it a quick and straightforward procedure. In the second case a partially deployed stent was lost in the proximal part of the radial artery. It was rewired, deployed, and post-dilated with a larger balloon. This enabled continuation of the procedure using the same access. Both cases were asymptomatic during 24 months of follow-up. It is crucial to avoid leaving artificial bodies in arteries supplying vital organs because stent-related thrombosis or stenosis may seriously compromise blood flow. Removing the stent via the introducer sheath should be considered the optimal treatment. Unfortunately it is common that a partially expanded stent will not pass through the sheath. The superficial location of the distal radial artery segment facilitates surgical cut-down with local anaesthesia. When dislodgement occurs in deeper segments of the radial artery, the benefits from cut-down seem to be less because the procedure might take more time and be more difficult - as in the presented case in which we decided to rewire and fully expand the stent in situ. Retrieval of the stent at all costs might have led to further complications; hence stent deployment may be a good alternative to retrieval in such cases.

No MeSH data available.


Related in: MedlinePlus