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Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don¡¯t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-134

A Challenging Case Report: Drifting Left Main Coronary Artery Stent!

By Ali Azhar Khan

Presenter

Ali Azhar Khan

Authors

Ali Azhar Khan1

Affiliation

North Shore Hospital, New Zealand1,
View Study Report
TCTAP C-134
Coronary - Complication Management

A Challenging Case Report: Drifting Left Main Coronary Artery Stent!

Ali Azhar Khan1

North Shore Hospital, New Zealand1,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

A 70-year man was brought in hospital by ambulance after waking up at midnight with back pain and shortness of breath. He was hemodynamically stable with bilateral symmetrical pulses and normal neurology. ECG showed inferior ST-elevation. He was brought in hospital for emergent cardiac catheterization. 

Relevant Test Results Prior to Catheterization

Hemoglobin 155 g/LSerum Creatinine 95 micromol/Lhs Troponin T 217 ng/LEchocardiogram showed normal left ventricular systolic function with inferior wall hypokinesis. 

Relevant Catheterization Findings

Successful percutaneous coronary intervention (PCI) of occluded right coronary artery was performed with a long drug-eluting stent (DES). Severe long proximal LAD disease with involvement of the distal left main (LM) artery was considered for staged PCI as patient declined surgery.

Interventional Management

Procedural Step

Via right radial approach, a 7.5F PB 3.0 sheathless Eaucath guide catheter was engaged in left coronary artery.  Intravascular ultrasound (IVUS) showed LM involvement and significant LAD-LM size mismatch. After stenting of LAD with a 4 x 38 mm DES, the LM was stented with a 5 x 8 mm DES with minimal overlap. Vigorous patient movement at the time of stent deployment resulted in dislodgement and proximal displacement of the stent. Fluoroscopy revealed the dislodged LM stent had drifted up towards the right subclavian artery over the guide catheter. LM stenting procedure was first safely completed by deployment of a 5 x 12 mm DES and post-dilated with a 6 mm non-compliant balloon. The drifting stent was then captured by the balloon at proximal end and brought back to brachial artery by simultaneous withdrawal of the balloon and the guide catheter, where the stent was secured and deployed. Inflation of BP cuff at high pressure at upper right arm did not cause any stent deformation. Patient was discharged next day in stable condition without any adverse outcome. 


Case Summary

This was an interesting case of PCI of left main artery complicated by proximal displacement and dislodgement of the stent into the aorta and drifting of the dislodged stent over the guiding catheter. The displaced stent was safely captured by balloon trapping and retracted by simultaneous withdrawal of the guide and balloon catheters proximally, to be deployed in the brachial artery. This was an unusual complication related to abrupt patient movement during stent deployment in the left main artery. Maintaining wire position is the key to avoid losing the stent in the circulation which can then be safely manipulated to a size-matched peripheral vessel for deployment.