lost stent

[gizmo14]

while attempting to place stent in artery running along front of heart, stent became dislodged and lost. Dr. couldn't find it. What are the dangers of this? Side effects? What do we need to worry about now?

[ed34]

In the case shown, I believe the surgeon managed to drag the stent back far enough to enter the aorta. It certainly wasn't left in the coronary arteries because there is no way it could find its way to a leg from there. Blood in the heart has to go through capillaries which are basically thinner than hair. I'm sure a collapsed stent would not fit through capillaries. I can't think of any good detection method here, maybe a perfusion scan would be wise to ensure blood flow hasn't been compromised anywhere in the heart.

[kenkeith]

"The aim of this retrospective study was to determine the incidence of stent loss during interventional procedures and to identify the associated immediate and long-term consequences of such loss. We evaluated 36 cases in which the stents were prematurely displaced from the stent delivery device. Five stents were completely removed from the vascular system successfully. Five stents could not be retrieved from the coronary circulation and led to significant adverse events in 3 patients, in whom the lost stents were not excluded by the placement of another stent. In 26 patients, peripheral embolism below the renal arteries occurred after successful stent retrieval from the coronary arteries. Of these 26 patients, 1 patient died during hospital stay, unrelated to the peripheral stent loss. Additional follow-up examinations were performed for 20 of the remaining 25 patients. Clinical patient status and the ankle-brachial index were evaluated 59 ± 30 months after stent loss. All patients were free of any stent-related peripheral ischemic symptoms. We also attempted to determine the exact physical locations of the lost stents using computed tomography during follow-up. In 15 patients, we were able to detect the stent in the peripheral arteries using computed tomography. In conclusion, if stents cannot be retrieved from the coronary system, severe problems may occur. Stent loss with peripheral embolization is asymptomatic in long-term follow-up".

Sue: Recently my husband underwent coronary stent implantation.  It was
  successful. Prior to this implantation, another attempt was made on
  the same day, that was unsuccessful. According to the doctor, the
  deployment balloon failed, due to a hole in the balloon.  The doctor
  managed to get the stent below the abdominal artery, where he lost
  it. Despite reassurances from the doctor that the stent will most
  likely lodge somewhere in my husband's right leg, we are still
  uncertain.

Medhelp expert:
Dear Sue,
>>>>>>>As explained by your physician, the lost stent will travel downstream from where it was lost. Most likely it will lodge in one of the small arteries of leg. The complications from this usually are acute. Fortunately, your husband did not have any problem in his legs acutely. This suggests that the sent has probably traveled to a small vessel without major functional significance. The long term consequences from this are rare. It is very unlikely to get claudications or such symptoms of arterial insufficiency from this as the stent is very small in diameter and usually goes to a small blood vessel without major functional consequence. Venous ulcers can not occur from this as the stent is on the arterial side of the circulation and so can not jeopardize the venous flow.
I hope I have adequately responded to your concern. Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).

[Flycaster305]

I don't think the study abstract says there are no long term problems, it just says that there is no morbidity noted.  

I'm not a health professional, but wouldn't a CAT scan reveal the location of the lost stent?  

[ed34]

It doesn't say how long the stents had been in the patients yet it claims no problems long term?

[erijon]

For what it's worth, below is some information from a study concerning lost stents. You may want to read the entire study;

The Long-Term Consequences of Lost Intracoronary Stents
DENNIS W. DUNNING M.D. 1 , JOEL K. KAHN M.D. 1 , 2 WILLIAM W. O'NEILL M.D. 1
  1 Division of Cardiology, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
Correspondence to   2 4600 Investment Dr., Suite 200; Troy, MI 48098. Fax: [phone].
Copyright 2002 Futura Publishing Company, Inc.
ABSTRACT
The aim of the study was to determine the incidence of lost or misplaced stents and to identify associated immediate- and long-term consequences. The study reviewed 11,881 cases with one or more intracoronary stents. From this group 40 cases were identified where stents were prematurely displaced from the stent delivery device. Sixteen were removed with bioptomes or snares. Three were removed surgically. Of the 21 remaining stents, 7 were deployed at a site remote from the target lesion and 14 were lost. Nine of the 14 were known to be below the aortoilliac bifurcation and the other 5 embolized to unknown locations. Stent loss is rare in intracoronary intervention. Removal or peripheral deployment is the best option, but there was no immediate or long-term morbidity associated with lost stents in this study.


Good luck, I hope it works out for you.

Jon

[ed34]

I've read a few cases where a stent has prematurely detached from the catheter before deployment. Sometimes the site is ballooned with the cardiologist believing he is expanding the stent, but when the balloon is removed, the stent isn't there. However, every case I have seen has reported the stent being retrieved. Maybe it would be worth seeking a second opinion.

[gizmo14]

the dr said that it is very small and they looked for it but couldn't find it in the artery or around the heart. He said that he felt a tug when he was pulling it out. He said that he believed that it was in the crook of the guide but that they couldn't see it because it is also made of metal. He said that it wouldn't be floating around when we asked. He said that it wasn't inflated. he noticed when they pulled it out that it was gone. He said that there was so much calcification that it would make it hard to see. He also said that this happens sometimes. he said that my father would need to be on plavix for the rest of his life.

[ed34]

My God that is Terrible. How can a stent be lost? I mean, it's not possible is it?
The problem, whereever it has ended up in your coronary arteries, it will lodge and end up causing stenosis or/and clotting. I hope they wasn't having a sick joke with you, not thinking you would take it seriously?
For a stent to become dislodged, it would have already been inflated. This means it would not be small enough to travel into smaller vessels, it wouldn't go very far at all.
I'm sure they would have detected it on the scan.

[Flycaster305]

Well, that's certainly the first time I've seen a post with this issue and I've perused this board for twelve years.  

I think I'd contact the medical school/teaching hospital staff in your state and tell them of your situation.  At the same time, I'd contact your insurance company, and raise holy hell with the doctor who lost the stent.  A call to an attorney would make considerable good sense to me.  I would do all this quickly, it sounds dangerous.