PCI Complicated by Stent Dislodgment due to Hole in the Stent Delivery System

A 64 years old female with a past history of anterior wall MI and stent deployment at proximal LAD 7 years ago. She underwent angiography due to NSTEMI. The angiogram shows significant diffuse stenosis at middle to distal LAD distally to a patent old stent. Uneventful balloon pre-dilatation was performed at this lesion and a Resolute Onyx 2.25/22 mm was advanced easily into the dilated lesion. Several attempts of stent deployment failed since no pressure was generated by the inflation device. While trying to pull back the stent it was trapped proximally in the old stent and dislodged from the balloon (figure 1). At this stage the patient became ischemic and the blood pressure dropped to shock level. Balloon re-insertion into the dislodged stent failed. Another wire and balloon were passed parallel and outside the un-deployed stent which was then crushed by several balloon inflations to resume blood flow in the LAD followed by patient stabilization. Another 2.25/30 mm Resolute Onyx stent was deployed to cover the lesion and the crushed stent with final good result (figures 2,3). The patient was doing well and went home the day after. Under inspection of the catheter that carried the dislodged stent, a hole was found at the junction of the soft and hard parts of the catheter (Figure 4). The company that manufactured this stent was informed of the event.