Keywords
PCI; Stent loss; Reasons
Abstract
A lady, 67 years old, 60 Kg, about 7 hours she was admitted to local hospital due to acute chest pain. She was diagnosed with acute anterior wall myocardial infarction and received thrombolysis treatment with Reteplase and loading dose of aspirin and clopidogrel following a standard dual antiplatelet therapy strategy. Her symptoms were quickly relieved and reperfused according ECG criteria. And then she was transferred to Zhengzhou University People’s Hospital about 17 hours after her chest pain. Her first ECG in our hospital still showed anterior wall acute myocardial infarction changes (Figure 1). She didn’t have histories of hypertension and diabetes. At the tenth day, echocardiography showed: LVEDd = 52 mm, EF53 %; SPECT showed ischemic necrotic change (isotope filling defect) at anterior wall and apex. She had coronary angiography at AMI 12th day and the result showed : RCA diffuse atherosclerosis without significant stenosis; LM normal; LCX normal; Middle LAD was severe diffuse stenosis around 80-90% accompanied by severe calcification which involved with first diagonal branch orifice (B2 type lesion) (Figure 2). Through communication with patient and their families, finally we decided coronary artery intervention for LAD lesion. Because of the LAD and D1 special anatomical structure, we planned to use CULOTTES technology. With right radial artery approach, 6000u common heparin (100u/ kg body weight) was given through 6F sheath side arm, verapamil 5 mg was given to prevent radial artery spasm. We selected 6 F EBU 3.5 guiding catheter (ID = 0.72), 2 BMW wires into the distal LAD and D1, 2.5 X15 B Braun balloon to pre-dilate LAD and D1, 10atmx10 seconds respectively. China-made Firebird II (Shanghai Microport, China) 3.0 X23 stent was implanted from LAD to D1, 16 atm x 10 seconds deployed the stent (Figure 3), TIMI blood flow was good. Diagnal BMW wire was inserted into the LAD from stent strut mesh. A 2.5 X15 B Braun balloon was reused to pre-dilate stent strut mesh about 10-12 atm. When we pull back first LAD BMW wire, we met very high resistance. When the BMW wire was out, we can see distal wire (opaque X-ray segment about 30 mm) left in LAD between LAD intima and the stent (distal wire fractured) (Figure 4). We concerned that the left wire could not be removed easily and had a little effect on blood flow and prognosis, so we planned to implant
Citation
Gao C, Li M, Rao L, Chen Y, Chen C and Hu D. Rare Reason Analysis for Stent Loss during PCI Procedure. SM J Cardiolog and Cardiovasc Disord. 2017; 3(1): 1010.