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CASE20191002_002
| CORONARY - Complications | |
| Stent to Coil Inside the Heart: A Very Rare Angioplasty Complication | |
| Suresh Davis1 | |
| Rajagiri Hospital, India1, | |
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[Clinical Information]
- Patient initials or identifier number:
MAN
-Relevant clinical history and physical exam:
40 year old male with no history of diabetes or hypertension with strong family history of CAD came with ECG suggestive of acute anterior wall myocardial infarction. His coronary angiogram revealed total thrombotic occlusion of ostio proximal LAD and tight stenosis of circumflex artery.He underwent primary angioplasty with 2.75 x 48 XIENCE Xpedition stent to LAD with good results.
 16107408_C NO 1815_C NO 1815_1.mp4 16107408_C NO 1815_C NO 1815_2.mp4 16107408_C NO 1815_C NO 1815_41.mp4-Relevant test results prior to catheterization:
His echo showed RWMA in LAD territory withLVEF of 40 %, no significant MR or significant TR or pulmonary arteryhypertension.Grade I diastolic dysfunctionRepeat ECG after primary angioplasty showednormal sinus rhythm, good ST resolution in anterior leads.His creatinine was 1 mg% and Hb was 14 gm%,other investigations were with in normal limits.
- Relevant catheterization findings:
Elective LCX PCI: A runthrough wirewas used to cross the lesion in LCX and placed distally. Pre-dilatation donewith 2 x 15 semi complaint balloon, but a 2.5 x 40 mm DES could not negotiatethe lesion. While retrieving the stent, the stent slipped out the balloon andwas hanging over the wire. A coronary snare was used to retrieve the stent andit was removed. After multiple pre-dilatation of the lesion, a 2.25 x 28 DESwas deployed distally and 2.5 x 40 DES proximally with good results.
16107408_C NO 1820_C NO 1820_18.mp4 16107408_C NO 1820_C NO 1820_20.mp4 16107408_C NO 1820_C NO 1820_49.mp4 |
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[Interventional Management]
- Procedural step:
Coronary angiogram done showed a welldeployed stent in circumflex artery, but a distorted stent in LAD. On close examination, it was noted that awire like structure was overhanging from the proximal part of the LADstent into the left main and then into the aorta. When the coronary wires were checked therewere no breaks. It seems that few of the connecting linksin the LAD stent broke while retrieving the LCX stent making it to curl into acoil inside the heart. The LAD stent was later reinforced with a 3x 40 DES to LAD and 3.5 x 28 DES from LMCA to LAD and TIMI III flow attained.Patient survived this complication and isstill on follow up after 2 years of the index procedure.
16107408_C NO 1820_C NO 1820_82.mp4 16107408_C NO 1820_C NO 1820_112.mp4 16107408_C NO 1820_C NO 1820_115.mp4- Case Summary:
This case is first of its kind were retrieval of a stent from the circumflex artery caused distortion and breakage of a previously deployed stent in LAD. The stent became a coil in the heart which was subsequently reinforced with other stents and patient survived this dreadful complication. This whole complication happened from a simple mistake of not properly visualizing the entry of the coronary wire into the circumflex artery through the struts of LAD stent. This complication could have easily avoided by imaging.
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