What question did this study set out to answer?

To report a rare case of right coronary artery stent loss with ostial stent-in-stent entrapment and describe salvage via surgical extraction and bypass grafting.

January 10, 2026Journal of Cardiothoracic SurgeryOpen Access

Ostial right coronary artery stent loss, stent-in-stent entrapment, and subsequent surgical extraction

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Key result

Thorough interrogation and preparation of calcified lesions are linked to fewer PCI complications.

Why the study?

To highlight technical reasons for stent entrapment, percutaneous retrieval techniques, and the importance of a heart-team approach in preventing and salvaging complications after failed PCI.

Key Points

To report a rare case of right coronary artery stent loss with ostial stent-in-stent entrapment and describe salvage via surgical extraction and bypass grafting.
Assessed a 59-year-old male with multivessel coronary disease presenting with worsening angina who underwent elective right coronary artery percutaneous coronary intervention without prior lesion preparation or intracoronary imaging.
Evaluated the failure of endovascular retrieval following guide catheter removal, stent fracture, and entrapment.
Performed transesophageal echocardiography-guided foreign body extraction and on-pump coronary artery bypass grafting after multidisciplinary transfer.
Elective stenting of calcified lesions without calcium modification caused distal stent under-expansion, balloon fracture, and stent-in-stent entrapment in the right coronary artery ostium.
Guide catheter removal and arterial injury risk precluded endovascular retrieval and stent crushing, necessitating open surgical foreign body removal and surgical revascularization.
Surgical retrieval and coronary artery bypass revascularization resulted in an uneventful recovery, with the patient remaining symptom-free with preserved left ventricular ejection fraction at 1-year follow-up.

Structured PICO

Population

1 59-year-old man with a history of obstructive coronary artery disease, hypertension, hyperlipidemia, type 2 diabetes, obesity, and prior percutaneous coronary intervention (multiple DES to LAD for non-STEMI 2 years prior), presenting with accelerating angina and exertional dyspnea.

Intervention

Elective percutaneous coronary intervention (PCI) of a heavily calcified right coronary artery without lesion interrogation or preparation, complicated by stent loss and entrapment, followed by surgical foreign body removal and on-pump coronary artery bypass grafting (CABG).

Outcome

Successful surgical extraction of the entrapped stent and surgical revascularization

This case highlights the critical need for adequate lesion preparation in calcified coronary arteries and demonstrates successful surgical salvage for severe PCI complications like stent entrapment.

Implication

Case report supports lesion prep in calcified PCI; leaves open confirmation in prospective studies.

Abstract

Current guidelines recommend thorough interrogation of calcified lesions (intracoronary imaging, functional testing), and, if indicated, adequate lesion preparation (lithotripsy, atherectomy, cutting/scoring balloon) prior to percutaneous coronary intervention. This case highlights the technical reasons for this complication, discussion on various percutaneous retrieval techniques, and the critical importance of a multidisciplinary heart-team approach in preventing complications, but also in salvaging them after failed percutaneous coronary intervention.

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Published by Journal of Cardiothoracic Surgery · CC BY-NC-ND

Cite This Study

Saleem et al. (2026) studied this question. Thorough interrogation and preparation of calcified lesions significantly reduce the risk of complications during and after percutaneous coronary intervention.

synapsesocial.com/papers/696321d491e05aa366cb8195 https://doi.org/10.1186/s13019-025-03798-9

Topics

Percutaneous coronary intervention

Heart failure

HFrEF treatment

Chronic total occlusion PCI

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Implication

Case report supports lesion prep in calcified PCI; leaves open confirmation in prospective studies.

Ostial right coronary artery stent loss, stent-in-stent entrapment, and subsequent surgical extraction

Key Points

Structured PICO

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Ostial right coronary artery stent loss, stent-in-stent entrapment, and subsequent surgical extraction

Key Points

Structured PICO

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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Topics

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