How should I treat stent dislodgement in a STEMI patient resulting in dissection of left main and left circumflex arteries?
Kohli SK., Lim YP., Lai SH., Tan JW., Taggart D., Kharbanda R., Carrié D., Boudou N.
BACKGROUND: A 52-year-old female presented with acute anterior ST-elevation myocardial infarction (STEMI) within one hour of symptom onset to the emergency department. She was referred for urgent primary angioplasty. INVESTIGATION: Physical examination, laboratory investigations, ECG, urgent percutaneous coronary intervention (PCI). DIAGNOSIS: Single-vessel coronary artery disease (SVD). TREATMENT: Intended to stent culprit lesion. However, stent dislodged in left main coronary artery (LMCA) during attempted PCI to diffuse mid segment of left anterior descending (LAD). Initial attempt failed to retrieve the dislodged stent with snare. Dislodged stent removed with multiple wire technique, complicated by severe dissection in LAD and left circumflex artery back into the LMCA. The stent was trapped at tip of 6 Fr right femoral sheath, unable to be withdrawn. What next?