Koroner Girişimlerde Cihaz Embolizasyonları: Stent Sıyrılması
Özet
Perkütan koroner girişimlerde (PKG) cihaz embolizasyonu nadir fakat mortalite ve morbiditesi yüksek bir komplikasyondur. En sık koroner stentlerin kaybı görülmekle birlikte kılavuz tel uçları, anjiyoplasti balonları veya kateter kırılmaları da yaşanabilmektedir. Cihaz sıyrılması kalsifikasyon, proksimal açılanma, zayıf kılavuz desteği ve ön dilatasyon yapılmaması gibi risk faktörleriyle tetiklenir. Yönetimde geri alma, yerleştirme veya ezme seçenekleri mevcuttur; en sık küçük balon, çift tel ve loop snare teknikleri uygulanır. Sunulan vakada, 51 yaşında ST yükselmesiz miyokart enfarktüsü geçiren hastanın birinci diyagonal arterindeki stent sıyrılmış, loop snare ile geri alınırken bir ay önce sol ön inen artere (LAD) takılan eski stent de yerinden çıkmıştır. Her iki stent de snare ile başarılı şekilde çıkarılmış, ardından gelişen diseksiyon nedeniyle LAD-Diyagonal bifurkasyon lezyonuna mini-crush tekniğiyle stentleme yapılmıştır. Sonuç olarak, embolize cihazların çıkarılmasında standart bir yöntem olmayıp, tercih vakaya, operatör tecrübesine ve laboratuvar imkanlarına bağlıdır. Bu nedenle kateter laboratuvarları her türlü ekipmanı hazır bulundurmalıdır.
Device embolization during percutaneous coronary interventions (PCI) is a rare complication but carries significant mortality and morbidity. While lost coronary stents are the most frequent, fractures of guidewire tips, angioplasty balloons, or catheter tips can also occur. Stent dislodgement is triggered by risk factors such as calcification, sharp proximal angulation, weak catheter support, and direct stenting without predilation. Management strategies include retrieval, deployment, or crushing, with the small balloon technique, double-wire technique, and loop snare being commonly used. In the presented case, a 51-year-old patient with non-ST-elevation myocardial infarction experienced stent dislodgement in the first diagonal artery; during retrieval with a loop snare, a previous stent implanted in the left anterior descending (LAD) artery one month ago was also dislodged. Both stents were successfully removed using the snare, and due to subsequent dissection, the LAD-diagonal bifurcation lesion was treated using the mini-crush technique. In conclusion, there is no standard method for retrieving embolized devices, and the choice depends on the case, operator experience, and laboratory facilities. Therefore, catheterization laboratories must always keep necessary equipment ready.
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