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REC: Interventional Cardiology
versão On-line ISSN 2604-7276versão impressa ISSN 2604-7306
REC Interv Cardiol ES vol.5 no.2 Madrid Abr./Jun. 2023 Epub 18-Mar-2024
https://dx.doi.org/10.24875/recic.m22000325
IMAGES IN CARDIOLOGY
El stent olvidado
The forgotten stent
The forgotten stent
1Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
This is the case of a 78-year-old man with revascularized coronary artery disease 10 years ago (left anterior descending coronary artery and left circumflex artery) who was admitted to the hospital with signs of ST-segment elevation acute coronary syndrome. The angiography shows an unusual image on the proximal left anterior descending coronary artery that seems to be causing an angiographically significant stenosis (figure 1A,B). To confirm diagnosis, a catheter is unsuccessfully advanced with optical coherence tomography (OCT) guidance through a polymeric guidewire while trying to cross the most stenotic region. Two attempts are made after predilatation (with balloons of 1.5 mm and 2.5 mm in diameter) that prove unsuccessful. Afterwards, a guide catheter extension system is advanced (figure 1D) that successfully crosses the lesion facilitating the OCT that reveals the presence of an underexpanded coronary stent with complete endothelization, and a possible thrombus attached to it (figure 1C). Upon suspicion that this is the culprit lesion, decision is made to treat it. To crush the underexpanded stent against the lumen of the vessel, it is first effortlessly predilated using a 3.5 mm x 12 mm balloon. Afterwards, a 3.5 mm x 15 mm drug-eluting stent is implanted with good angiographic results (figure 1E). A new OCT confirms the excellent expansion of the new stent including the entire forgotten stent that is crushed between the new stent and the vessel endothelium (figure 1F).
Stent loss inside the coronary tree is a rare complication that can, however, be solved if removed during the procedure. However, when forgotten for years, the stent endothelizes and its extraction becomes complicated and is no stranger to complications. In these cases, the most efficient option is to exclude it by implanting a new drug-eluting stent.
The patients written informed consent was requested before publishing this article.
Received: June 07, 2022; Accepted: July 01, 2022