Percutaneous removal of a fully expanded SMART stent from the pulmonary artery using various adjunctive techniques

Jpn J Radiol. 2012 Oct;30(8):688-92. doi: 10.1007/s11604-012-0109-0. Epub 2012 Aug 10.

Abstract

A 36-year-old man with an implanted arteriovenous shunt for hemodialysis was referred for shunt malfunction. Venography of the right upper extremity showed occlusion of the subclavian vein, and a SMART stent was deployed. The fully expanded stent immediately migrated centrally into the left pulmonary artery. As initial efforts to pass a snare over the stent failed, we intentionally passed a microguidewire through stent interstices, snared the end of the microguidewire to create a loop, and pulled the stent/microguidewire/snare combination back into the right ventricle where it separated from the loop because of stent mesh destruction. As the stent remained in the right ventricle, we advanced a 0.035-in. guidewire into the stent lumen, passed an angioplasty balloon over the guidewire, inflated the balloon in the stent, and performed pull-back into the right distal external iliac artery. The stent was then surgically removed via a right inguinal incision without eliciting any complications. Although retrieval of the stent malpositioned in the pulmonary artery was difficult, we retrieved it safely by applying various adjunctive techniques.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Angioplasty, Balloon*
  • Arteriovenous Shunt, Surgical / adverse effects
  • Device Removal* / methods
  • Equipment Failure
  • Humans
  • Iliac Artery
  • Male
  • Pulmonary Artery*
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods
  • Stents*