Coronary Arrtery Stent Removal

By Raman Chawla
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Raman Chawla


Raman Chawla1


Caremax Superspeciality Hospital, India1
Complications - Complications

Coronary Arrtery Stent Removal

Raman Chawla1

Caremax Superspeciality Hospital, India1

Clinical Information

Patient initials or Identifier Number


Relevant Clinical History and Physical Exam

A 66years old female presented with  c/o chest pain  for duration of  1 dayH/o of profuse sweating  ,chest pain radiating to back andshoulder ,pain lasting for more than 20 mins, breathlessness gradual in onsetprogressive in nature , grade iii nyha, history of orthopnea +  no pnd, patient is diabetic and hypertensiveon regular medication ,no similar episodes in the pastO/e vitals within normal  limits Rs : b/l crepts  Cvs s1 s2 heard  Cns: normal 

Relevant Test Results Prior to Catheterization

Routine bloodinvestigations – Normal Troponin-T Positive Echo – Mild apical hypokinesia -EF 45% -No MR      CAG:   LAD - Type IIIlarge size vessel & shows 95% Eccentric, calcified lesion at proximalsegmentLCX - Small sizevessel & shows diffuse disease.RCA - Small sizevessel & shows diffuse disease.            

Relevant Catheterization Findings

Interventional Management

Procedural Step

Femoral approachGuiding catheter 6f jl 3.5 Guide wire 0.014 choice pt extra support. Predilated with 2.5 x 15 mm balloon. Femoral approach Guiding catheter 6f jl 3.5 Guidewire 0.014 choice pt extra support Pre dilated with 2.5 x 15 mm balloon. Attempted  withdrawal Stent  dislodged from  balloon  into left- main  coronary  artery. Second  guide & wire  fromcontralateral  femoral, Stent  snaired out Successful  coronary  angioplasty using  another stent Patient  discharged  after three days.Patient againpresented with chest pain - AWMI. Gross LVF, Echo – Dilated LV- Hypokinesia ofapex and anterior wall- Moderate MR- EF 20%.Coronary Angiography – LAD thrombus Re-Angioplasty Done Under  Cover Of Inj. Reoprot. Wire Crossed, ? Through Stent Struts Second Wire Crossed Difficult  Balloon Crossing. High  Pressure  Dilatation

Case Summary

Never withdraw the stent, Deploy there only, Carefulwithdrawal of stent in calcified vessel with proper alignment of guiding. Tryto withdraw stent, guide wire and guiding catheter as a total assembly. Snaringof stent from Left Main Coronary Artery technical expert required. Contralateral  femoral puncture  and  simultaneous wiring  if vessel goes into threaten occlusion beforeretrieval of previous wire. As previous wire will help in easy tracking down ofadditional wire. Double wire criss-cross technique. Crush the stent againstwall with another stent. Sub acute stent thrombus need aggressive management.