Abstract
A 62-year old male underwent treatment of a bifurcation lesion in the left anterior descending coronary artery using provisional stenting with a jailed wire technique. Severe longitudinal stent deformation and unravelment of the stent part proximal of the bifurcation occurred when we tried to pull the jailed wire from the side branch. The described case poses a caution on the use of this specific stent(-design) in bifurcation lesions.
Highlights
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Severe longitudinal deformation of a Medtronic Onyx stent occurred during bifurcation stenting using the jailed wire technique.
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This stent type is characterized by a helical structure that facilitates deliverability and overexpansion possibilities.
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The described case may question or even caution whether this type of stent has sufficient structural integrity to be used during bifurcation stenting when a jailed wire in the sidebranch is required.
1
Introduction
A good balance of stent characteristics is required to facilitate optimal use in bifurcation procedures.
2
Case report
A 62-year old male was scheduled for elective percutaneous intervention of a bifurcation lesion (medina 0,1,1) in the mid-part of the left anterior descending (LAD) coronary artery ( Fig. 1 , panel A) because of stable angina. The LAD was wired with a balanced medium weight (BMW) wire. After predilatation of the LAD lesion, the large second diagonal was wired with another BMW wire. A 2.25 × 26 mm Medtronic Onyx stent was subsequently placed at 14 atm in the LAD crossing the second diagonal branch. Afterwards there was significant pinching of the ostium of the diagonal which persisted after a proximal optimization technique (POT) with a 2.5 × 8 mm Sapphire Pro non-compliant balloon at 16 atm ( Fig. 1 , panel B). At that moment rewiring was performed. The wire in the LAD was successfully recrossed to the diagonal. While pulling back the jailed wire from the diagonal however, some resistance was felt and angio showed that the proximal part of the stent was unraveled.
