Cardiovascular Journal of Africa: Vol 26 No 1 (January/February 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015 e4 AFRICA
Case Report
Late coronary stent dislodgement following coronary
artery stenting
Ebuzer Aydin,Yucel Ozen, Sabit Sarikaya, Ozgur Arslan, Kaan Kirali, Mete Alp
Abstract
Recently, coronary artery stenting has been successful when
used as an intervention for percutaneous coronary artery
disease. However, the procedure may frequently produce
complications. Although rare, stent dislodgement is one such
complication, which may result in serious problems including
coronary artery dissection, myocardial infarction, peripheral
embolisation and death. Stent dislodgement is known to be
an early complication of the coronary artery stenting proce-
dure. In this case report, we present a 53-year-old male with
late coronary stent dislodgement. To the best of our knowl-
edge, no such case has been addressed in the literature to date.
Keywords: peripheral arteries, drug-eluting stent, complication,
limb ischaemia, embolisation, coil/device, transcatheter, left
main coronary disease
Submitted 4/8/14, accepted 27/11/14
Cardiovasc J Afr 2015; 26: e4–e7
DOI: 10.5830/CVJA-2014-073
In recent years, coronary artery stenting has been highly
successful for the percutaneous treatment of coronary artery
diseases.1,2 As a result, once-rare complications have become
more frequent.
Coronary stent dislodgement is one of these complications,
which may result in occlusion or distal embolisation following
peripheral or visceral drifting of the stent.1,3,4 It may even lead
to disruption of the coronary circulation, cardiac infarction,
embolisation of the cerebrovascular system, peripheral
embolisation and ultimately, death.1
Stent dislodgement has been reported in the literature as an
early complication of the coronary artery stenting procedure.
However, late coronary stent dislodgement has not been
addressed to date.
Case report
A 53-year-old male patient was admitted to our cardiology
out-patient clinic with severe right groin pain. The medical
history revealed hypertension, insulin-dependent diabetes
mellitus and a previous coronary artery stenting procedure nine
months earlier with a drug-eluting stent to the left main coronary
artery (LMCA) and left anterior descending artery (Fig. 1).
The physical examination showed palpable femoral and distal
arteries. There was no difference in the temperature or colour of
both limbs. However, the patient had severe groin pain.
He was in normal sinus rhythmwithout a history of peripheral
arterial disease. Coronary and peripheral angiographies were
performed simultaneously through the contralateral femoral
arteries. Coronary angiography revealed the LMCA stent was
absent. Peripheral angiography revealed a right femoral artery
flow defect with diminished distal flow (Fig. 2).
The patient was urgently operated on and a foreign body was
detected within the artery and removed. It was stent material
covered with tissue. The distal clamp was removed and the
retrograde flow was good. A 4-F Fogarty catheter was directed
to the distal and proximal artery to check the distal and proximal
segments. No thrombus or other foreign body was found. The
surgical procedure was successful.
After the procedure, the patient was symptom free and the
distal arteries of the right lower limb were palpable. Repeated
computed tomography showed that the LMCA had no
significant lesion after distal embolisation of the stent. The stent
in the left anterior descending artery was intact. The patient was
discharged after four days.
Discussion
Today, coronary stenting is a widely used percutaneous
intervention for the treatment of arterial diseases.1,2 The use of
drug-eluting stents (Sirolimus, Paclitaxel) has been significantly
increased, due to their low potential for restenosis.2
Along with their benefits, however, drug-eluting stents may
lead to complications, including challenges during deflation and
removal of the balloon, endothelial dysfunction, vasospasm,
hypersensitivity, infection, late malposition, late aneurysm
formation, late restenosis, late stent fracture, late stent thrombosis,
systemic and coronary embolisation and stent dislodgement.2,5-7
In our case, the patient had had a drug-eluting stent inserted,
which had become dislodged. As shown by coronary angiography,
the LMCA was too short and a drug-eluting stent was implanted
on the discretion of the previous cardiologist. The stent appeared
Kartal Kosuyolu Training and Research Hospital, Istanbul,
Turkey
Ebuzer Aydin, MD,
Yucel Ozen, MD
Sabit Sarikaya, MD
Ozgur Arslan, MD
Kaan Kirali, MD
Mete Alp, MD