A rare complication with remarkable stent shortening and successful recovery from the trouble
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CASE REPORT
A rare complication with remarkable stent shortening and successful recovery from the trouble Yoshitaka Goto • Tomohiro Kawasaki Hisashi Koga
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Received: 3 October 2011 / Accepted: 2 December 2011 / Published online: 28 December 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract Deployed coronary stent distortion is a rare complication, but can potentially occur during coronary intervention. We herein report a rare complicated case with remarkable stent distortion of longitudinal stent shortening and successful recovery from a trouble using a Corsair microcatheter. Keywords Percutaneous coronary intervention Complication Stent
Introduction Deployed coronary stent distortion or crushing is a rare complication, but can potentially occur during coronary intervention due to balloon inflation after incorrect guide wire crossing, entrapment by devices such as an intravascular ultrasound, filter wire, etc. We herein report a rare complicated case with remarkable stent distortion of longitudinal stent shortening during percutaneous coronary intervention (PCI) and successfully recovered from a trouble using a Corsair microcatheter (Asahi Intec, Japan).
Case presentation A 60-year-old male, with a history of hypertension, dyslipidemia, and insulin-independent diabetes mellitus, and
Y. Goto (&) T. Kawasaki H. Koga Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120 Tenjin-cho, Kurume 830-8577, Japan e-mail: [email protected]
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with stent (2.5 mm mini VISION stent, Abbott Vascular Japan, Japan) deployment in the mid-right coronary artery (RCA) because of inferior myocardial infarction, was admitted to our hospital with a diagnosis of recurrent angina pectoris. Single photon emission computed tomography (SPECT) revealed infero-posterior myocardial ischemia. His coronary angiography (CAG) showed no restenosis of the previous mini VISION stent in the mid RCA but showed 2 significant new lesions in both the proximal (#1) and distal (#4AV) RCA (Fig. 1). We therefore performed PCI with a 6 Fr AL-1 guide catheter system via the right radial artery. After pre-dilation of both lesions with 2.5 mm low compliant ballooning (Quantum Maverick, Boston Scientific Japan, Japan), we attempted to deliver a 2.5 9 15 mm everolimus-eluting stent (EES, Abbott Vascular Japan, Japan) to the distal lesion, but the EES delivery failed even after using deep seating of the guide catheter or the parallel wire technique because of the tortuous nature of the vessel of the RCA. Moreover, during the guide catheter manipulation, the proximal (#1) lesion became hazy and an acute occlusion was concerned, a new 3.0 9 24 mm EES was therefore deployed to the proximal lesion and post-dilated at maximum 18 atmospheres (Fig. 2a). Then, we again attempted to deliver the 2.5 9 15 mm EES to the distal lesion with the buddy wire technique, but it was again not possible to deploy it to the lesion. When retrieving the undelivered stent, some resistance was felt at the deployed EES
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