We present a case of a 64-year-old man with severe in-stent restenosis of a bare metal stent (4.0×15 mm) in the left anterior descending (LAD) (Figure A). Because the coronary angiogram suggested massive neointimal hyperplasia in the stent, we chose to use a debulking device to reduce the in-stent tissue and gain sufficient lumen area. Intravascular ultrasound (IVUS) showed diffuse intimal hyperplasia and no stent malapposition (Figure A-a–d). Directional coronary atherectomy (DCA) was performed at 20 psi to the distal section of the stent, followed by the proximal section. There was an abnormal sound after the last attempt at DCA and the device was entrapped within the stent. Careful retrieval revealed a metal mass wrapped around the housing of the device (Figure B). Subsequent coronary angiography showed a filling defect in the mid-LAD (Figure C). To evaluate the vessel’s condition, both IVUS and coronary angioscopy were performed and revealed no stent structure; angioscopy showed mobile, peeled intima but no thrombi (Figure D,E; Supplementary Movies 1,2). We implanted a new bare metal stent.
It is very rare that a stent will be avulsed by a coronary intervention.1
Attention should be paid to stent avulsion when performing DCA for in-stent restenosis.
Funding / Disclosures
None.
Supplementary Files
Supplementary Movie 1.
IVUS image after DCA.
Supplementary Movie 2.
Coronary angioscopic image after DCA.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-20-0610
Reference
- 1.
Matsuhiro Y, Shutta R, Egami Y, Nishino M, Tanouchi J. Orbital atherectomy through left main stent struts complicated by catheter entrapment and stent avulsion. JACC Case Rep 2020; 2: 709–710.
