Successful Retrieval of Stripped Coronary Stents Using the Twisted Guide Wire Technique

Abstract

Stent stripping during percutaneous coronary intervention is a rare but serious complication. The patient was admitted to the emergency department with chest pain. Electrocardiography revealed ST elevations in the anterolateral leads. The patient was urgently taken to the catheter laboratory. A guiding catheter without a hole was used to imagine the left coronary system. To avoid dumping, two holes were manually drilled into the distal region of the catheter with the needle tip. Occlusion was observed in the proximal region of left anterior descending artery. It was decided to implant a stent. However, when the stent arrived distal in the catheter, strain was felt. When the stent was advanced to the left main coronary artery (LMCA), it was observed that the stent detached from its balloon in the LMCA. It was planned to remove the stent using the twisted guide wire technique. In this technique, the guide wire inside the stripped stent lumen was not retracted. A second guide wire was advanced distally outside the stent lumen. Subsequently, these two parallel wires were twisted 10-15 times until the stent was trapped by the guide wires with the help of the torquer device. Twisted wires were pulled back. While the wires were retrieving, the trapped stent between guide wires was pulled back. Subsequently, a new stent was successfully implanted into the lesion. After the procedure, the damaged catheter and the removed stent were investigated. The distal inner lumen of the guiding catheters not smooth at the edges of the manually opened side holes because of protrusions. It was thought that the stent was stuck to these inner protrusions of the holes and detached from the balloon. Manually drilling a hole in the guiding catheter or any intervention disrupting the structure of the catheter should be avoided. The twisted guide wire technique is an alternative and effective method to retrieve a stripped stent.

Keywords

• complication
• stent stripping
• twisted guide wires