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外周锚定:一种处理冠状动脉支架移位的补救策略

Peripheral Parking: A Bailout Strategy for Managing Dislodged Coronary Stents.

作者信息

Padhiary Satyajit, Kumar Devesh, Arya Anbhigya Kumar, Khan Maaz Ahmad, Singh Saurabh Kumar

机构信息

Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.

出版信息

Cureus. 2025 Jul 25;17(7):e88757. doi: 10.7759/cureus.88757. eCollection 2025 Jul.

DOI:10.7759/cureus.88757
PMID:40861771
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12375392/
Abstract

Coronary stent dislodgement is a rare but potentially life-threatening complication during percutaneous coronary intervention (PCI). It may occur due to complex anatomy, heavy calcification, tortuous vessels, or equipment malfunction, leading to embolization, vessel injury, or myocardial infarction if not promptly addressed. We present a case of stent dislodgement during transradial PCI, wherein a dislodged undeployed coronary stent migrated to the peripheral arterial system (left common iliac artery) seen on non-contrast computed tomography (NCCT). On subsequent fluoroscopy, the stent was seen aligned with the vessel contour and with good flow across it, so parked permanently without compromising distal flow or limb perfusion. The patient remained hemodynamically stable, and no short-term vascular complications were observed. This case highlights the peripheral parking technique as a practical bailout strategy in scenarios where retrieval is not feasible and the stent is inaccessible or poses a risk of further embolization.

摘要

冠状动脉支架移位是经皮冠状动脉介入治疗(PCI)期间一种罕见但可能危及生命的并发症。它可能由于解剖结构复杂、严重钙化、血管迂曲或设备故障而发生,如果不及时处理,会导致栓塞、血管损伤或心肌梗死。我们报告一例经桡动脉PCI期间发生支架移位的病例,其中一个未展开的移位冠状动脉支架迁移至外周动脉系统(左髂总动脉),这在非增强计算机断层扫描(NCCT)上可见。在随后的荧光透视检查中,可见支架与血管轮廓对齐且血流良好,因此永久性放置,未影响远端血流或肢体灌注。患者血流动力学保持稳定,未观察到短期血管并发症。该病例突出了外周放置技术作为一种实用的补救策略,适用于无法进行取回操作且支架无法触及或有进一步栓塞风险的情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d56b/12375392/2cd54450bcb7/cureus-0017-00000088757-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d56b/12375392/2cd54450bcb7/cureus-0017-00000088757-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d56b/12375392/2cd54450bcb7/cureus-0017-00000088757-i01.jpg

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本文引用的文献

1
Retrieving a Peripherally Dislodged Coronary Stent: A Last Resort Approach.取出外周移位的冠状动脉支架:一种最后的手段
Cureus. 2025 Feb 13;17(2):e78941. doi: 10.7759/cureus.78941. eCollection 2025 Feb.
2
Coronary Artery Stent Dislodgement and Loss in the Bloodstream: A Case Report and Management Options.冠状动脉支架脱落并在血液中丢失:病例报告及处理选择。
Am J Case Rep. 2022 Sep 17;23:e937598. doi: 10.12659/AJCR.937598.
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Left main stenting with stent dislodgement and entrapment in the common femoral artery: a successful transcatheter stent retrieval.
左主干支架置入术伴支架移位并嵌顿于股总动脉:经导管成功取出支架
Am J Cardiovasc Dis. 2021 Jun 15;11(3):421-428. eCollection 2021.
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Intravascular Imaging Guidance of Left Main PCI: Nice to Have or Must Have?左主干经皮冠状动脉介入治疗的血管内成像指导:锦上添花还是必不可少?
JACC Cardiovasc Interv. 2020 Feb 10;13(3):358-360. doi: 10.1016/j.jcin.2019.11.009.
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Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease.经桡动脉与经股动脉途径用于冠心病患者的诊断性冠状动脉造影及经皮冠状动脉介入治疗
Cochrane Database Syst Rev. 2018 Apr 18;4(4):CD012318. doi: 10.1002/14651858.CD012318.pub2.
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Catheter Cardiovasc Interv. 2005 Nov;66(3):333-40. doi: 10.1002/ccd.20449.
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Extraction of previously deployed stent by an entrapped cutting balloon due to the blade fracture.因刀片断裂,采用套扎切割球囊取出先前植入的支架。
Catheter Cardiovasc Interv. 2002 Oct;57(2):239-43. doi: 10.1002/ccd.10317.
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Incidence, management, and outcome of stent loss during intracoronary stenting.冠状动脉内支架置入术中支架移位的发生率、处理及结局
Am J Cardiol. 2001 Sep 1;88(5):565-7. doi: 10.1016/s0002-9149(01)01742-8.
9
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Catheter Cardiovasc Interv. 2000 Dec;51(4):432-40. doi: 10.1002/1522-726x(200012)51:4<432::aid-ccd12>3.0.co;2-1.
10
Stent Complications.支架并发症。
J Invasive Cardiol. 1998 Sep;10(7):385-395.