Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 57 years-old, smoker with underlying diabetes mellitus, hypertension, dyslipidemia, was presented with one episode of generalized central chest pain and discomfort. It was not associated with nausea, vomiting, profuse sweating or syncope. There was no symptoms of heart failure. Has a family history of ischemic heart disease.
The physical examinations were unremarkable.
Relevant test results prior to catheterization
Full Blood Count
WBC : 6.9 x 103
Hemoglobin : 11.6g/dl
Platelet : 213
Renal Function Test
Urea : 7.7 mmol/L
Potassium : 4.0 mmol/L
Sodium : 139 mmol/L
Creatinine : umol/L
Liver Function Test
Albumin : 29 g/L
Alanine Aminotransferase : 10 U/L
Alkaline Phosphatase : 71 U/L
PT : 10.2 S
INR : 1.0
APTT : 25.2 S
ECG : Sinus rhythm, no ST, T or Q wave changes
Exercise Stress Test : Positive
METS Achieved : 12
ST segment depression noted at V3 To V6
Relevant catheterization findings
Right radial artery punctured and 6Fr sheath introduced. EBU 3.5 6Fr guide catheter engaged to left main (LM). Estimated of 52 mm significant lesion was recognized in LCX artery and our strategy to deploy and overlap using two stents. LCX artery was wired with Run through NS without difficulty. Distal lesion predilated with Sprinter Legend 2.0 x 20 at 14 atm and stent Terumo Ultimaster 2.5 x 28 at 12 atm deployed. The second stent for the proximal lesion, Terumo Ultimaster 3.0 x 24 introduced and unfortunately slipped from its balloon at the LM.
Small Mini trek balloon 1.2 x 8 deployed distal to the stent and attempted to pull into the guider but failed. Another Mini trek balloon 2.0 x 8 deployed distal to the stent. Initially the stent was able to pull from the LM but unable to withdraw into the guider due to flawed stent. We were decided to pull out the balloon-stent-guider together into the right radial artery 6Fr sheath but failed.
Subsequently, right femoral artery 14Fr sheath inserted and Mullin 10Fr sheath advanced into ascending aorta. Then the stent retrogradely pushed using MPA 1 5Fr but failed. Next, EBU 6Fr guide used to push back the stent into the Mullin sheath. The stent withdrawn together with the sheath successfully.
Percutaneous coronary intervention (PCI) using stent, has been established to improve in patient’s symptoms and clinical outcome. Stent dislodgement is one of the rare complication of PCI and may be fatal. Patient may complicate into coronary embolization, hence requiring emergent coronary artery bypass surgery and some cases may lead to death. Equipment design has been improved for the last few decades to reduce these complications. This case illustrated to us the measures that had been taken to our unfortunate patient who had stent dislodgement while going for elective PCI. The dislodged stent successfully taken out after few attempts and techniques being carried out.