Nazeer Ali Hyder, Hameed Abdul, Balouch Iram Jehan, Bhatti Khalid Iqbal, Khan Kamran
Aga Khan University Medical College, Karachi, Sindh, Pakistan.
National Institute of Cardiovascular Diseases (NICVD), Karachi, Sindh, Pakistan.
JACC Case Rep. 2025 Jul 30;30(21):104396. doi: 10.1016/j.jaccas.2025.104396.
Stent dislodgement during percutaneous coronary intervention (PCI) is a feared complication, associated with coronary tortuosity and calcifications. Similarly, the balloon can become entrapped inside the vessel after puncture or failure to deflate. Both these mishaps can cause serious consequences including a myocardial infarction, stroke, and death and may require surgery as the last resort.
We report a case of an elderly dyspneic man presenting with anterior wall myocardial infarction. During PCI to the left anterior descending artery, the stent dislodged but was successfully retrieved with the twirling wire technique. During postdilatation of both stents with a noncompliant balloon, failure of deflation led to balloon entrapment and attempts to pull it resulted in fracture of the shaft. Successful recovery of the compromised apparatus was made by snaring the proximal wire end attached to the rest of the trapped equipment.
The Twisted Guidewire technique was used to retrieve a dislodged stent, aided by a pre-positioned wire. Common retrieval methods include small-balloon, two-wire, and snaring techniques. Balloon shaft rupture is managed based on fragment location. Preventive measures include lesion preparation and guide catheter extensions. The simultaneous occurrence of stent dislodgement and balloon shaft fracture is rare and may relate to tortuous, calcified vessels..
TAKE-HOME MESSAGE: The risk of rare, life-threatening PCI complications in complex cases necessitates stringent precautions and operator expertise in identifying and managing both common and rare events.
经皮冠状动脉介入治疗（PCI）期间支架移位是一种令人担忧的并发症，与冠状动脉迂曲和钙化有关。同样，球囊在穿刺后或未能放气时可能会被困在血管内。这两种意外情况都可能导致严重后果，包括心肌梗死、中风和死亡，并且可能需要手术作为最后的手段。
我们报告一例老年男性呼吸困难患者，表现为前壁心肌梗死。在对左前降支进行PCI时，支架移位，但通过旋转钢丝技术成功取出。在用非顺应性球囊对两个支架进行后扩张时，放气失败导致球囊被困，试图拉出球囊导致球囊杆断裂。通过套住附着在被困设备其余部分的近端钢丝末端，成功回收了受损器械。
在预先放置的钢丝辅助下，采用扭曲导丝技术取出移位的支架。常见的取出方法包括小球囊、双线和套索技术。根据碎片位置处理球囊杆破裂。预防措施包括病变预处理和引导导管延长。支架移位和球囊杆断裂同时发生的情况很少见，可能与血管迂曲、钙化有关。
在复杂病例中，PCI罕见但危及生命的并发症风险需要严格的预防措施以及操作人员在识别和处理常见和罕见事件方面的专业知识。
