Akademik Veri Yönetim Sistemi
kardiyovasküler akademi kongresi , Girne, Kıbrıs (Kktc), 18 - 22 Eylül 2024, ss.1-4
Rare stent complications ,including
dislodgement of stent , unexpanded stent
,stent fracture and stent loss can ocur
during percutaneous coronary
interventions .
Rupture of coronary stent balloon is a rare
complication of coronary interventions,it
can lead to stent dislodgement,stent loss
and can lead to serious events including
cerebrovascular embolism,myocardial
infarction or even death.
İn this case report we present a semiexpanded stent due to rupture of the stent
balloon.
Case report
A 73-year-old male patient presented
to the emergency department with
chest pain was diagnosed with
NSTEMİ,he has a history of coronary
PCİ performed 4 years ago.
on the angiogram there was no
significant lesion in the CX and RCA
and there was an in-stent %80 lesion
in the distal LAD stent that was
implanted before, there was a %70
lesion in the proximal portion of the
stent, a %95 lesion was observed in
the first Diagonal branch.
we started the procedure by engaging
a 6F Judskin guiding catheter to the
LMCA ostium, after that a floppy
guidewire was crossed through the
first diagonal another floppy guidewire
was crossed through the distal LAD
stent successfully, we predilated the
lesion in the first diagonal branch by
using a 2x12 mm balloon and then we
planned to implant a 2,5x21 mm
Firehawk DES to the residue lesion.
while inflating the stent balloon we
recognized a dye leakage and we
observed that the stent was not
expanding successfully(figure 1).we
performed the stent boost technique to
evaluate the expansion of the stent,we
observed that only the head and the end
portions of the stent were inflated and
the middle portion was unabled to
inflate correctly (figure2).
we planned to pull the ruptured balloon
of the stent and to inflate a 1,25x12 mm
PTCA,2x15mm PTCA, 2,5x15 mm NC
respectively in the unexpanded part of
the stent.
But while trying to pull the balloon we
noticed that the struts of the stent were
moving backwards with the balloon so
we decided to pull the stent back from
the coronary tree,because the head of
the stent was expanded we could not
take the stent back into the catheter and
because the risk of stent loss we pulled
all of the equipment back while keeping
the stent struts attached to the tip of the
catheter.The stent was removed from
the patient without any dissection or
perforation(figüre 3)
After that we engaged an EBU 3.5
catheter to the LMCA and we
successfully implanted a 2,25x19 mm
FİREHAWK DES to the first diagonal and
a 2,75x13 mm FİREHAWK DES to the
distal LAD and the procedure was
performed with a TIMI-3 flow in the LAD
and first diagonal.
DİSCUSSİON
Rupture of the stent balloon is a rare
complication of coronary interventions .
A reasonable explanation to our case
may be rupture of the stent balloon
during inflation .the rupture might have
been due to calcific lesions , or a
manifacturing defect in the balloon
Another possible scenario may be
perforation of the balloon done by the
operatör during insertion into the
guidewire or placement into the guiding
catheter .
Unexpanded or semi-expanded stent
are rare complications in the era of the
second -generation stents ,
İn the era of the first-generation stents
these complications were more likely
to develop because the stent struts
were crimped to the balloon by the
operatör .
However these complications may still
happen and the operatör should be
aware of material related
complications and know how to
manage them .