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Controlled removal of a dislodged stent causing myocardial ischemia 1 year after stent placement.

The potential complications of stent dislodgement include coronary occlusion and thrombosis, myocardial infarction and even life-threatening systemic embolization. Since dislodged stents can cause severe complications, removal of the stent should be the main goal. A 61-year-old female presented to the clinic for exertional dyspnea and chest pain increasing for the last two months. Patient had a history of percutaneous closure of atrial septal defect (ASD) 10 days ago and stent implantation to the left circumflex artery (LCX) and right coronary artery (RCA) 1 year ago in an another hospital. We reviewed the cine angiographic images during the closure of ASD and detected an unopened stent in the RCA ostium causing total occlusion. About one third of the stent was out of the coronary artery (Video 1, 2. See corresponding video/movie images at www.anakarder.com). Myocardial perfusion scintigraphy revealed ischemia in RCA regions. We took the patient to catheter laboratory for removing the unopened stent. Coronary angiography confirmed that the stent was dislodged and endothelialized. We grabbed the stent using snare and pulled out the stent gradually (Fig. 1). Aortic root imaging was performed in order to visualize the complications such as aortic dissection and was normal. No other complications developed. Since patient had ischemia in RCA region we planned intervention to chronic total lesion in RCA after 1 month considering the endothelia recovery.