Why the study?
How should stent dislodgement and subsequent severe coronary dissection be managed during primary PCI for STEMI?
How should stent dislodgement and subsequent severe coronary dissection be managed during primary PCI for STEMI?
This case highlights the severe complications of stent dislodgement during primary PCI and the challenges associated with percutaneous retrieval techniques.
Emphasizes caution with multiple-wire retrieval due to dissection and entrapment risk; leaves optimal dislodgement management open in STEMI PCI.
BACKGROUND: A 52-year-old female presented with acute anterior ST-elevation myocardial infarction (STEMI) within one hour of symptom onset to the emergency department. She was referred for urgent primary angioplasty. INVESTIGATION: Physical examination, laboratory investigations, ECG, urgent percutaneous coronary intervention (PCI). DIAGNOSIS: Single-vessel coronary artery disease (SVD). TREATMENT: Intended to stent culprit lesion. However, stent dislodged in left main coronary artery (LMCA) during attempted PCI to diffuse mid segment of left anterior descending (LAD). Initial attempt failed to retrieve the dislodged stent with snare. Dislodged stent removed with multiple wire technique, complicated by severe dissection in LAD and left circumflex artery back into the LMCA. The stent was trapped at tip of 6 Fr right femoral sheath, unable to be withdrawn. What next?
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Kohli et al. (2013) studied this question.
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