STENT DISLODGEMENT DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENT WITH MYOCARDIAL INFARCTION AND PULMONARY EMBOLISM: A CASE REPORT.

Abstract

A 74-year-old patient was hospitalized because of pulmonary embolism and deep venous thrombosis. Standard medication therapy was administered but the inferolateral ST elevation myocardial infarction (STEMI) occurred only a few hours after the admission. Coronary angiography was performed, and circumflex artery (ACx) occlusion verified. Initially, thromboaspiration was done, the lesion was predilated with a semi-compliant (SC) balloon and drug eluting stent (DES) was placed. The control angiogram showed a filling defect at the occlusion site, while the expanded stent was visualized in the left main (it did not adequately detach during inflation and was pulled retrograde to the guide catheter). We attempted to remove the stent by passing an SC balloon over the stent and it was pulled under fluoroscopic guidance to the brachial artery. An effort was then made to extract the stent using ˝twisting guide wire technique˝, but without success. Finally, the stent was grasped with an EN Snare® device and removed completely through the sheath. The procedure ended with the repositioning of the guide catheter and implantation of a new stent. In further hospitalization, gastroenterological workup was planned, but because of septic shock and COVID infection, the patient died due to multiorgan failure.