The Metal vs. Calcium in Complex Atherosclerosis

Furtula M, Ilić I, Miljković A , Đoković I , Stojčić M , Antonijević M and Dobrić M

Institute for Cardiovascular Diseases “Dedinje”, Heroja Milana Tepića 1, Serbia University of Belgrade Faculty of Medicine, Dr Subotića 8, Serbia

^*Correspondance to: Matija Furtula 

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Abstract:

Coronary stent dislodgement is an infrequent but serious complication during Percutaneous Coronary Intervention (PCI) that can lead to severe complications, including thrombosis, myocardial infarction, and sudden death. We present a complex case of a 72-year-old patient with significant left main disease who underwent PCI with stent placement. Unfortunately, the stent became entrapped in the Left Main artery (LM) during the extraction process, leading to longitudinal deformation and protrusion into the aorta. To optimize the chances of successful and safe stent extraction while minimizing complications, we employed multiple imaging techniques. The initial attempt to extract the stent resulted in fracture, leaving a portion of the stent trapped within the coronary artery. Subsequent PCI procedures were performed to address the remaining stent, with successful snare extraction from the ascending aorta. Optical Coherence Tomography (OCT) confirmed the presence of a dissection in the proximal Left Anterior Descending artery (LAD) without a previously implanted stent. Further stenting using an "inverted T" technique was performed with favorable outcomes. This case highlights the challenges of stent retrieval and emphasizes the importance of preoperative imaging assessment and meticulous lesion preparation to prevent complications. Moreover, the successful application of OCT and the use of snare devices in stent extraction demonstrate valuable tools in managing complex scenarios involving stent entrapment. In conclusion, stent dislodgement during PCI remains a rare but potentially life-threatening complication, and careful consideration of patient-specific factors and imaging modalities is essential to optimize outcomes in such complex cases.

Keywords:

Coronary stent dislodgement; Percutaneous coronary intervention stent entrapment; Snare device; Optical Coherence Tomography (OCT)

Cite the Article:

Furtula M, Ilić I, Miljković A, Đoković I, Stojčić M, Antonijević M, et al. The Metal vs. Calcium in Complex Atherosclerosis. Clin Case Rep Int. 2023; 7: 1582.