Maniobra para rescate de stent atrapado en el árbol coronario / Rescue maneuver for entrapped stent in the coronary tree

Describimos el caso de dos pacientes que durante la angioplastia los stents se desprendieron del balón sin expandir y quedaron atrapados en el árbol coronario. En un paciente el stent quedó enclavado en la curvatura de la arteria circunfleja y en el otro paciente en el tronco común distal. Los stents se extrajeron en el primer caso tras avanzar un balón de bajo perfil a través del stent y en el otro tras colocar otra guía exterior al stent y situar un balón distal. En ambos casos se hinchó el balón distal a los stents y se logró desenclavar al retirar el balón hacia el catéter guía y después todo el sistema.

We describe two patients in whom stents dislodged from the unexpanded balloon during angioplasty and remained trapped in the coronary tree. In one patient the stent was located in the curvature of the circumflex artery and, in the other patient, it was detected in the distal left main artery. Retrieval of the undeployed stents was accomplished in the first case after advancing a low profile balloon through the stent and, in the second case, after placing a second guidewire exterior to the stent. In both cases, the balloon was inflated distally and the stents were dislodged after pulling the balloon back towards the guiding catheter and then withdrawing the whole system.

Atrapamiento de la guía de angioplastía después de la implantación de un stent: descripción de dos casos y revisión de la literatura / Angioplasty guidewire entrapment affer stent implantation: report of two cases and review of the literature

Angioplasty guidewire entrapment, with or without retention of a fractured segment, is an infrequent complication and may lead to acute coronary ischemia due to thromboembolic occlusion. Management can be surgical, conservative or percutaneous. We describe two patients in whom the guidewire remained entrapped with the stent during the pullback maneuver after successful stent implantation. In one patient, we managed to extricate a metallic guidewire using the balloon as a wedge. In the other patient, a fragment of the non-metallic guidewire tip, with hydrophilic coating, remained trapped after being [quot ]cut[quot ] by the stent during traction towards the ostium while attempting removal. The retained segment was isolated from the blood stream by implanting a synthetic coronary stent graft. We emphasize the high risk of [quot ]cutting[quot ] this type of non-metallic guidewire in case of engagement with the stent, and we review the literature of this rare complication.