Nanavati, Amit, MD

Patel, Nainesh C, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineVisualization and Management of a DistallyEmbolized Stent After ST-Elevation MyocardialInfarctionAmit Nanavati MDLehigh Valley Health NetworkNainesh C. Patel MDLehigh Valley Health Network, nainesh_c.patel@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Cardiology Commons, and the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtNanavati, A., & Patel, N. (2013). Visualization and management of a distally embolized stent after ST-Elevation myocardial infarction.Poster presentation.Lehigh Valley Health Network, Allentown, PennsylvaniaAmit Nanavati, MD; Nainesh Patel, MDBackground:Visualization and Management of a Distally Embolized Stent After ST-Elevation Myocardial Infarction© 2013 Lehigh Valley Health Network•		Stent embolization is a rare complication in the current era of percutaneous intervention with an incidence as low as 0.3%.1•		Common causes of this phenomena include dislodgement from the balloon, direct stenting as well as attempting to cross a calcified lesion.2 •		Previous methods for removing the embolized stent have included snares, balloons and distal protection devices.3•		“Crush” stenting as well as conservative management have also been advocated. •		Visualization can also be a challenge as angiography and intravascular ultrasound have inherent limitations. Case Presentation:•		63 year-old male with a history of tobacco abuse, morbid obesity and hypertension who presented with 4 hours of substernal chest pressure.•		Initial electrocardiogram demonstrated ST-elevation in the inferior leads and he was taken for emergent coronary angiography.  •		A severe lesion was seen in the proximal RCA (Figure	1) and a Veriflex 5.0 x 16 mm bare-metal stent was placed in the proximal RCA with no angiographically apparent residual stenosis. (Figure	2).•		A second stent placement was also attempted in the proximal RCA, however, visualization was noted to be suboptimal due to body habitus.  •		Later that day, the patient had recurrent symptoms of chest pain and inferior lead ST-elevations. •		Repeat coronary angiography (Figure	3) with the assistance of optical coherence tomography noted that the second RCA stent was partially deployed and had embolized into the PDA. (Figures	4-5).Results:•		The stent was then crushed against the vessel wall with a 2.75 x 23 mm Xience Everolimus eluting stent. •		The embolized stent could not be fully covered with the new stent. •		Optical coherence tomography also visualized a 60% lesion in the deployed RCA stent, which was restented. Conclusion:•		The patient was discharged two days later in stable condition. •		This case illustrates that optical coherence tomography is a useful tool in visualizing distally embolized stents when limitations make other methods impractical.Figure 1 — Initial severe stenosis in the proximal RCA.Figure 2 — No apparent residual stenosis in the RCA.Figure 4 — Optical coherence tomography depicting embolized stent.Figure 5 — The full extent of the embolized stent could not be covered.Figure 3 — Angiography demonstrating likely location of stent embolization in the PDA (arrow).References:1	 	Saleh	L.	et	al.	Exp	Clin	Cardiol	2010;	15(3):	e70-2.	2	 	Farman	M.	et	al.	J	Pak	Med	Assoc	2010;	60(2):	140-2.3	 	Guiguari	P	et.	al.	J	Invasive	Card	2005;	17(3).	

Visualization and Management of a Distally Embolized Stent After ST-Elevation Myocardial Infarction

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1239&context=medicine

Visualization and Management of a Distally Embolized Stent After ST-Elevation Myocardial Infarction

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