Double coronary stent loss with aortic migration and iliac embolization successfully managed by snare retrieval: a case report

Background: Coronary stent loss during percutaneous coronary intervention (PCI) is rare but potentially life-threatening, particularly when device deformation is accompanied by aortic migration or systemic embolization. Case presentation: A 45-year-old man with diabetes mellitus and hypertension presented with high-risk unstable angina. Angiography demonstrated a critical calcific proximal left anterior descending (LAD) lesion followed by a long distal lesion. After successful proximal LAD stent deployment, a second stent failed to cross the proximal edge of the implanted stent because of strut interaction and snagging. Repeated manipulation caused entrapment, elongation, and severe deformation of the undeployed stent, which protruded into the ascending aorta. The patient developed transient hypotension, sinus bradycardia, and vomiting and was stabilized with intravenous fluids, atropine, and norepinephrine. Snare retrieval through femoral access captured the deformed stent; however, traction dislodged the previously implanted proximal LAD stent, which embolized to the right common iliac artery bifurcation. Urgent computed tomography localized the embolized stent. During the same procedural session, briefly interrupted for imaging, both stents were successfully retrieved using an Amplatz GooseNeck snare through bilateral femoral access. Definitive LAD PCI was then completed with overlapping drug-eluting stents, restoring TIMI 3 flow without residual stenosis. The complete procedure was accomplished within approximately 3 h. Conclusion: Sequential loss of two coronary stents with aortic migration and iliac embolization is exceptionally uncommon. Careful hemodynamic stabilization, prompt cross-sectional imaging, and stepwise snare retrieval can permit successful single-session percutaneous management and avoid emergency surgery.