1. Successful transdradial removal of a dislodged coronary stent
Italo Porto
Interventional Cardiology Unit
Università Cattolica del Sacro Cuore
Rome, Italy
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2. Italo Porto, MD, PhD DISCLOSURES
I have no real or apparent conflicts of interest to report.

3. Case
Male, 66 years
High blood pressure, hypercholesterolemia, family history of cardiovascular disease
History of coronary artery disease from 2007 with previous PCI on RCA (BMS) and LAD (DES)
Relapse of angina in August 2008 with positive exercise stress test
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4. Coronary angiography Fondi, 28 Giugno 2008
RCA: ostial 85% lesion proximally to previously implanted stent
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5. Coronary angiography Fondi, 28 Giugno 2008
LAD: mid-distal 55% lesion no instent restenosis; LCX: distal collateralized occlusion
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6. Revascularization strategy
Percutaneous coronary intervention to proximal right coronary artery
Drug pre-treatment: ASA 100 mg daily, clopidogrel loading dose 300 mg
Anticoagulation: heparin 100 UI/kg  ACT >250 sec
Vascular Access: Right radial artery
Guiding catheter: Judkins Right 4 6F
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7. Wires in
Guide Wire: 2xBalance Middleweight Universal 0.014”
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8. Stent: Chrono Carbostent 3.5 x 16 mm
Direct stenting
Stent: Chrono Carbostent 3.5 x 16 mm
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9. Incomplete ostial coverage
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10. Stent: Chrono Carbostent 3.5 x 8 mm
Overlap stenting
Stent: Chrono Carbostent 3.5 x 8 mm
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11. Ooopss…..

12. A simple solution to a complex problem ?
Wrong!!!

13. Capture of dislodged stent
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14. Stent withdrawal
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15. Stent withdrawal
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16. What next?
A 3.5 mm deployed stent is engaging the right radial artery
The 6 French radial sheath is exchanged for a 7 French one over the two wires
An Amplatz GOOSE NECK Microsnare 4 system is implemented to achieve stent removal
Size Matters
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17. Korean group, CCI 2001

18. Stent snaring
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19. Stent snaring
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20. Stent removal
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23. Stent: Chrono Carbostent 4.0 x 12 mm
Ostium stenting
Stent: Chrono Carbostent 4.0 x 12 mm
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24. Final result
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25. Final radial artery angiography
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26. Discussion
Stent dislodgement is an uncommon PCI complication which can be secondary to severe coronary angulation, coronary calcification, and direct stenting
Two previous report described transradial stent retrieval using small-balloon technique and forceps
We describe a safe and successful retrieve of a coronary stent dislodged in ascending aorta using a Microsnare system
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27. Thank You!!!