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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 deployment in the proximal segment of radial artery
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Figure 0008: Stent deployment in the proximal segment of radial artery

Mentions: The Whisper MS guidewire was inserted and a stent (3.0 × 15 mm Xience Prime, Abbott) was positioned (Figure 6). During the attempt to deploy the stent, a pressure rise on the pump pressure gauge was not observed. Close inspection revealed a broken three-way cock connecting the pump with the balloon catheter. The connector was replaced. During this manoeuvre the stent was moved proximally to the lesion. An attempt to push it across the lesion failed, and an attempt to pull it back into the guiding catheter was performed. It was also impossible probably due to a slight but invisible inflation of the balloon during the first attempt to deploy the stent. On the second attempt the stent went into the guiding catheter. The balloon was partially inflated (6 atm) to press the stent against the catheter wall. Thereafter the catheter, the trapped stent, and the wire were removed slowly towards the sheath (Figure 7). After completing the pull back, there was no stent remaining in the catheter. Inspection under X-ray showed that the stent was lost in the proximal segments of the radial artery. The stent was rewired and deployed in situ using 3.5 × 15 mm and 4.0 × 15 mm balloons (Figure 8). Because a good result was obtained, the PCI was continued using the same approach. Introducing the 6 Fr guiding catheter led to stent distortion (Figures 9–10), and another 4.0 × 15 balloon was used to reshape it properly (Figure 11). After this, the guiding catheter was replaced with a 5 Fr catheter (Figure 12) and the procedure was completed without further complications. The next 14 months of patient follow-up were uneventful.


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 deployment in the proximal segment of radial artery
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0008: Stent deployment in the proximal segment of radial artery
Mentions: The Whisper MS guidewire was inserted and a stent (3.0 × 15 mm Xience Prime, Abbott) was positioned (Figure 6). During the attempt to deploy the stent, a pressure rise on the pump pressure gauge was not observed. Close inspection revealed a broken three-way cock connecting the pump with the balloon catheter. The connector was replaced. During this manoeuvre the stent was moved proximally to the lesion. An attempt to push it across the lesion failed, and an attempt to pull it back into the guiding catheter was performed. It was also impossible probably due to a slight but invisible inflation of the balloon during the first attempt to deploy the stent. On the second attempt the stent went into the guiding catheter. The balloon was partially inflated (6 atm) to press the stent against the catheter wall. Thereafter the catheter, the trapped stent, and the wire were removed slowly towards the sheath (Figure 7). After completing the pull back, there was no stent remaining in the catheter. Inspection under X-ray showed that the stent was lost in the proximal segments of the radial artery. The stent was rewired and deployed in situ using 3.5 × 15 mm and 4.0 × 15 mm balloons (Figure 8). Because a good result was obtained, the PCI was continued using the same approach. Introducing the 6 Fr guiding catheter led to stent distortion (Figures 9–10), and another 4.0 × 15 balloon was used to reshape it properly (Figure 11). After this, the guiding catheter was replaced with a 5 Fr catheter (Figure 12) and the procedure was completed without further complications. The next 14 months of patient follow-up were uneventful.

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