STENT DISLODGEMENT DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENT WITH MYOCARDIAL INFARCTION AND PULMONARY EMBOLISM: A CASE REPORT/GUBITAK STENTA TIJEKOM PRIMARNE PERKUTANE KORONARNE INTERVENCIJE KOD PACIJENTA S INFARKTOM MIOKARDA I PLUCNOM EMBOLIJOM: PRIKAZ SLUCAJA

A 74-year-old patient was hospitalized because of pulmonary embolism and deep venous thrombosis. Standard medication therapy was administered but the inferolateral ST elevation myocardial infarction (STEMI) occurred only a few hours after the admission. Coronary angiography was performed, and circumflex artery (ACx) occlusion verified. Initially, thromboaspiration was done, the lesion was predilated with a semi-compliant (SC) balloon and drug eluting stent (DES) was placed. The control angiogram showed a filling defect at the occlusion site, while the expanded stent was visualized in the left main (it did not adequately detach during inflation and was pulled retrograde to the guide catheter). We attempted to remove the stent by passing an SC balloon over the stent and it was pulled under fluoroscopic guidance to the brachial artery. An effort was then made to extract the stent using 'twisting guide wire technique', but without success. Finally, the stent was grasped with an EN Snare[R] device and removed completely through the sheath. The procedure ended with the repositioning of the guide catheter and implantation of a new stent. In further hospitalization, gastroenterological workup was planned, but because of septic shock and COVID infection, the patient died due to multiorgan failure. Key words: stent, device removal, percutaneous coronary intervention, acute coronary syndrome, complications Bolesnica u dobi od 74 godine hospitalizirana je pod klinickom slikom plucne embolije te duboke venske tromboze lijeve potkoljenice. Zapoceta je standardna medikamentna terapija, no nekoliko sati po prijemu dolazi do razvoja STEMI inferolateralne regije. Ucini se hitna koronarografija te verificira okluzija cirkumfleksne arterije. Najprije se ucini tromboaspiracija Export kateterom, zatim se lezija predilatira sa SC balonom i postavi DES Ultimaster Tansei 3.0 x 38 mm. Kontrolni angiogram nadalje pokazuje defekt punjenja na mjestu okluzije, dok se raspuhani stent vizualizira u ostiju debla lijeve koronarne arterije (nije se adekvatno odvojio od balona tijekom inflacije te je povucen retrogradno do vodeceg katetera). Potom se preko stenta provuce SC balon te se balon, stent, vodeci kateter i zica uz fluoroskopsku kontrolu izvlace do radijalne arterije u podlakticu. Zatim se neuspjesno pokusa izvlacenje stenta tehnikom s vise dilatacijskih zica koje se provuku kroz stent. Finalno se pomocu EN Snare katetera uhvati stent te se uz deformaciju strukture uspije izvuci u c