Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon

Su Young Kim; Seung-Hee Han; Kyung Han Kim; Moo Hyun Kim; Jong Sung Park

doi:10.7180/kmj.2013.28.1.55

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Kim, Han, Kim, Kim, and Park: Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon

Case Report

Kosin Medical Journal 2013;28(1):55-60.

Published online: 19 January 2013

DOI: https://doi.org/10.7180/kmj.2013.28.1.55

Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon

Su Young Kim, Seung-Hee Han, Kyung Han Kim, Moo Hyun Kim, Jong Sung Park

Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea

Corresponding author: Jong Sung Park, Department of Internal Medicine, College of Medicine, Dong-A University Hospital 1, 3-ga Dongdaesin-dong, Seo-gu, Busan 602-714, Korea TEL: +82-51-240-5040 FAX: +82-51-242-5852 E-mail: thinkmed@dau.ac.kr

Received 16 August 201225 September 2012 Accepted 17 October 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.

Keywords: Complication, Coronary artery, Intervention, Stent

REFERENCES

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Fig. 1.

Electrocardiogram after coronary artery dissection and acute total occlusion of left circumflex coronary artery showed ST segment elevation and T wave inversion in V4-V6, I, and aVL leads.

Fig. 2.

(A) Dislodged stent (arrow) was remained in proximal LCX. (B) Magnified view of the dislodged stent of 2.75 X 24 mm in size (arrow). (C) Coronary angiography showed coronary artery dissection and total occlusion of proximal LCX. (D) Magnified view of the dislodged stent. A floppy tipped guide wire was inserted to the lumen of dislodged stent (within arrowheads). (E) However, the guide wire entered to the false lumen of distal LCX formed by dissecting intimal flap. (F) Another guide wire was inserted and two guide wires were advanced alternately by parallel wire technique. Finally, a guide wire found the true lumen of distal LCX. LCX: left circumflex coronary artery.

Fig. 3.

(A) A guide wire in false lumen was reinserted to the true lumen (B) A small balloon was positioned within the dislodged stent and inflated. (C) Partially expanded dislodged stent was fully expanded by a balloon with larger diameter. (D) Coronary angiography after direct expansion of the dislodged stent showed partial restoration of distal LCX flow. (E) A overlapping stent of 2.5 X 32 mm in size was implanted to cover coronary artery dissection. (F) Distal LCX flow was fully recovered after coronary artery intervention. LCX: left circumflex coronary artery.

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