Successful Retrieval of Dislodged Stent and Fractured Balloon After Entrapment in One Setting.

BACKGROUND

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.

CASE SUMMARY

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.

DISCUSSION

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.