Coronary trunk dissection with stent displacement: points to remember!

Zanettini, Marco Tulio; Zanettini, Jacira Pisani; Zanettini, João Otavio

doi:10.5935/abc.20130237

LETTER TO THE EDITOR

Eletrocor Laboratório de Diagnóstico Ltda, Caxias do Sul, RS - Brazil

Mailing address

Keywords: Coronary Vessels; Dissection; Angioplasty, Balloon, Coronary.

Dear Editor,

We would like to congratulate Marchiori et al¹ for the successful conduction of a rare and serious complication which happened during hemodynamic procedure. Nevertheless, we consider that some considerations about this case should be made.

The stent migration, precipitated by know predictors², tends to follow the antegrade coronary flow. In this case, the opposite situation has occurred, with stent embolization to the aorta and brachial arteries. Therefore, there are some questions to be presented. Is there any possibility that the balloon catheter was inadvertently pulled during post-dilation? Was there spontaneous migration of the stent or recovery of the device through the snare loop or inflated balloon? Why was a conventional stent used for treating the left coronary trunk, as there is evidence advocating the use of pharmacological devices?³

References

1. Marchiori GGA, Ximenes Meireles GC, Kreimer S, Galon MZ. Stent dislodgement in the treatment of left main coronary artery dissection. Arq Bras Cardiol.2013;100(6):e71-e74.
2. Ahmar W, Malaiapan Y, Meredith IA. Transradial retrieval of a dislodged stent from the left main coronary artery. J Invas Cardiol. 2008;20(10):545-7.
3. Mattos LA, Lemos Neto PA, Rassi A Jr, Marin-Neto JA, Sousa AGMR, Devito FS, et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre intervenção coronária percutânea e métodos adjuntos diagnósticos em cardiologia intervencionista. Arq Bras Cardiol.2008;91(6 supl.1):1-58.