Successful Percutaneous Stentectomy a Decade After Coronary Stent Implantation.

OBJECTIVE

Percutaneous coronary stentectomy may be performed for in-stent restenosis involving a protruding coronary stent at an aorto-ostial location.

KEY STEPS: The key procedural steps are as follows: 1) advance an 8-F guiding catheter and a 6-F guide-extension catheter in a mother-daughter configuration, along with a goose-neck snare; 2) position the snare around the protruding segment of the stent; 3) advance the guide extension to secure the snare loop and apply traction; and 4) once resistance is overcome, withdraw all equipment en bloc and inspect to confirm retrieval of the stent within the snare.

POTENTIAL PITFALLS: Potential pitfalls include stent elongation without fracture, injury to the aorto-ostial region, embolization of stent fragments, and failure to successfully engage the protruding stent with the snare.

TAKE-HOME MESSAGES: Protruding coronary stents can hinder revascularization. This case demonstrates that percutaneous snare-assisted stentectomy can be performed nearly a decade later to enable successful revascularization; however, potential complications must be carefully considered.