Author + information
- Kenichi Karube, MD∗,
- Yusuke Fujino, MD∗,
- Toru Naganuma, MD∗,
- Satoko Tahara, MD∗,
- Shotaro Nakamura, MD∗,
- Sunao Nakamura, MD∗ and
- Antonio Colombo, MD†∗ ()
- ∗Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
- †Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Antonio Colombo, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy.
A 72-year-old man presented with exertional angina 22 months after percutaneous coronary intervention in the proximal segment of left anterior descending artery (LAD) and first diagonal branch (D1) with the provisional T-stenting and small protrusion (TAP) technique (Xience Prime 2.5 × 23 mm stent on D1, Abbott Vascular, Santa Clara, California). Coronary angiography demonstrated significant in-stent restenosis of the mid-LAD (Figure 1A).
A floppy guidewire was passed through the lesion. Then, a balloon (Lacrosse non-slip element, 2.5 × 13 mm, Goodman Co. Ltd., Nagoya, Japan) was advanced and inflated. After deflation, we removed the balloon with some difficulty and observed a deformed stent attached to it (Figure 1F). Coronary angiography confirmed removal of the D1 stent and showed focal stenosis with probable dissection in the D1 (Figures 1C and D). Frequency-domain optical coherence tomography revealed intimal tears (Figures 2Ba and 2Bc) and trails of the extracted stent struts (Figure 2Bb) (Online Video 1). A drug-eluting stent was successfully inserted into the D1 (Figure 1E).
To our knowledge, this is the first report of the extraction of a previously implanted side-branch stent following the TAP technique. This rare complication appeared to be due to the entrapment of the deflated balloon in the struts of the D1 stent protruding into the LAD, secondary to the guidewire passing through the struts. Histology of tissue adhered to the extracted stent identified fibrous thickening of the intima and part of the media and focal inflammation. The connection between the vessel wall and the stent might have been loosened secondary to the suppression of neointimal proliferation by everolimus and/or chronic inflammation. The TAP technique is associated with favorable clinical outcomes (1). However, this report suggests that care is needed when passing a guidewire through a lesion distal to the bifurcation previously treated with the TAP technique, and a J-type wire should be considered.
For a supplemental video and its legend, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation