Although the number of PCI procedures has significantly increased over the years, the severe
complications are rare. Stent embolization is a rare complication of coronary stenting, at a rate of 0.2%.
We report on a case with a 64-year-old man admitted to the emergency department with unstable angina
and stent embolization during the coronary angiography and successful retrieval of a coronary stent from
the left anterior descending (LAD) artery, which migrated to the left popliteal artery. The stent was finally
Although the number of PCI procedures has significantly increased over the years, the
incidence of stent loss has decreased and remains at a rate of 0.2%, as a result to the greater
experience of interventional cardiologists and improvements in equipment, especially due
to utilization of pre-mounted stents [1,2]. Systemic and coronary embolization’s are the
consequences of stent dislodgement and can lead to serious complications such as acute
closure of the affected vessel, coronary thrombosis and subsequent myocardial infarction.
A 64-year-old man admitted to the emergency department with unstable angina.
Symptoms begun 4 hours later and lasted for 30 minutes, but there was no chest pain at the
time of admission. Resting ECG showed T inversion in the precordial leads but there was no
rise in cardiac troponin serum levels. His coronary risk factors include dyslipidaemia and
smoking. Next day the patient was taken to the cardiac catheterization laboratory. Coronary
angiography revealed a long, heavily calcified lesion in the mid-left anterior descending (LAD)
After an initial balloon dilatation, a 2nd generation drug eluting stent (Nobori 3x30 mm)
was delivered to the LAD. Guideliner mother and child technique was used. The attempt to
pass through the stenosis was failed and the stent was dislodged from its delivery balloon.
The delivery balloon was drawn back without the stent, which moved to the left main (LM)
coronary artery. Another balloon (2x10mm) was delivered distally through the stent, which
inflated up to 2 atm. The stent could not be withdrawn into the guide catheter, probably due to
stent malformation (damage). So, we decided to try “en block” retrieval of the inflated balloon,
the dislodged stent, the guide wire and the catheter as far as the common femoral artery.
Unfortunately, the stent could not insert into the lumen of the sheath in the femoral artery, so
it was released in the peripheral circulation. Fluoroscopy revealed that it was migrated to the
left popliteal artery.
The patient was stable during the procedure, without chest pain and without signs of limb
ischemia. The PCI attempt was abandoned and a decision for CABG was taken. During the
CABG procedure the stent from the left popliteal artery was removed surgically (Figures 1-3).
Close examination of the removed stent revealed disruption and malformation, which could
explain the difficulty encountered while attempting to retrieve it into the guide catheter or
into the femoral artery sheath (Figure 4).
Stent loss and its migration is a rare complication of coronary
stenting, probably due to advances in equipment design and
worldwide utilization of pre-mounted stents. However, anatomical
circumstances, such as arterial tortuosity in the location proximal
to the lesion and significant calcification of the lesion, increase
the frequency stent dislodgement and embolization . It is wellknown
that direct stenting may be associated with a higher risk
of this complication, presumably due to the increased resistance
to stent advancement through the lesion, but in our case an initial
balloon dilatation was performed. Angulated coronary arteries may
also cause difficulties during stent procedures [3,4]. In this specific
case, the calcification of the lesion was the main determinant, which
was responsible for the stent dislodgement.
Nonsurgical removal or peripheral deployment is the best option
for this complication, but surgery may be indicated if percutaneous
retrieval attempts fail . Different percutaneous retrieval
techniques have been described to retrieve embolized stents from
the coronary system and the peripheral circulation. Low-profile
angioplasty balloon catheters, loop snare biliary forceps, twirling
two wires around the stent, cook retained fragment retriever and
basket retrieval devices have been successfully used .
In our case the first care was to withdraw the stent from the
LM artery and to avoid embolization to the cerebral circulation.
Snare loop is often the device of first choice due to its effectiveness
and safety . However, there was no snare loop available in our
department in order to use it for the retrieval of the stent. The use
of low-profile balloon catheters was an alternative choice, which is
also very effective, especially in this case where the stent was still
riding on the guide wire and was deployed enough to advance a
balloon catheter through its lumen. Unfortunately, the stent was
lost and migrated with the blood stream to the left popliteal artery.
There are many reports of stent embolization and successfully
percutaneous retrieval from peripheral vessels, such as from renal
artery, pedal artery or abdominal aorta [7-9]. However, in our
case the non-surgical retrieval from the left popliteal artery was
impossible, because the stent was already damaged and it has been
migrated far enough below the aortoiliac bifurcation.
Dittfeld A, Gwizdek K, Jagielski P, Brzęk A, Ziora K (2017) Evaluation of the relationship between orthorexia and vegetarianism with use BOT (Bratman Test for Orthorexia). Psychiatr Pol 51(6):1133-1144.
Professor, Chief Doctor, Director of Department of Pediatric Surgery, Associate Director of Department of Surgery, Doctoral Supervisor Tongji hospital, Tongji medical college, Huazhong University of Science and Technology