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Case 134: Manual of PCI - Stent loss

A patient with multivessel coronary artery disease (severe stenosis in the proximal/mid LAD and the proximal circumflex with severe calcification) was referred for CABG but declined and was referred for complex PCI. The circumflex was treated first. Balloon delivery was successful but the balloon ruptured. Orbital atherectomy was performed, followed by balloon angioplasty and successful stenting. A balloon could not be delivered to the LAD due to the severity of the LAD stenosis and severe calcification. After orbital atherectomy a 3.0x40 mm DES was deployed from the LAD ostium to the mid LAD. The stent expanded well but there remained disease distally. We attempted to deliver a 2.75x18 mm DES to the mid LAD, but the stent came off the balloon in the proximal LAD. We tried to retrieve the stent using the small balloon technique without success. We deployed the lost stent inside the previously deployed proximal LAD stent and used a guide extension to deliver another DES to the mid LAD with a nice result. The proximal circumflex appeared suboptimal, hence stenting was performed from the circumflex into the left main using the provisional technique. After POT, the LAD was rewired followed by kissing balloon inflation and final POT with an excellent final result as confirmed by IVUS. The patient had an uneventful recovery.