Case report-snare loop retrieval of an unnoticed lost stent after 3 months: the later, the harder.

Background: Stent loss is a rare but serious complication of percutaneous coronary interventions (PCI) that can disrupt coronary flow. This report details the retrieval of an intracoronary stent 3 months after its unnoticed loss during a complex PCI procedure.

Case Summary: A 62-year-old male presented with an inferior STEMI due to right coronary artery (RCA) occlusion, treated by primary PCI. The angiogram revealed a severe calcified stenosis at the left anterior descending artery (LAD)/diagonal bifurcation. In absence of anterior wall motion abnormality, LAD/diagonal stenting was attempted with a DK crush strategy. Despite repeated pre-dilatation, stent delivery to the diagonal branch was unsuccessful. An anchoring balloon attempt led to loss of wire position with guiding catheter extubation and transient chest pain. A septal-left ventricle perforation was evidenced and treated with prolonged balloon inflation. No pericardial effusion was noted. A TIMI 3 flow was achieved in both LAD and diagonal (with an ostial dissection). A follow-up procedure was scheduled three months later. The control angiogram revealed a new intermediate lesion in the left main artery, caused by a dislodged stent extending from the LM to the first diagonal's ostium. Stent retrieval using an EN snare was successful and caused a dissection, necessitating stenting from the LM to proximal LAD.

Discussion: Stent loss during PCI, though rare, requires prompt management through stent crushing or retrieval. Unrecognized stent loss can lead to partial endothelialization, complicating retrieval and causing additional complications. It is thus of utmost importance to always verify stent integrity following unsuccessful delivery to recognize immediately the stent loss.