Percutaneous Treatment of an Injured Coronary Stent Using the Looping Wire Technique
A 70-year-old man with unstable angina presented to our emergency room. He had a history of essential hypertension. Sixty-six months previously, he had been admitted owing to unstable angina pectoris and two coronary stents had been implanted at the first obtuse marginal (OM) branch (2.5×20 mm Taxus®, Boston Scientific, Natick, MA) and the proximal left anterior descending artery (LAD) (3.0×33 mm Cypher®, Cordis Corporation, Miami Lakes, FL), respectively.\nDiagnostic coronary angiography showed significant stenosis (90% diameter stenosis) at the proximal left circumflex (LCX) and moderate stenosis at the proximal LAD with distal left main involvement. We deployed two everolimus-eluting stents (EESs) at both the proximal LCX (3.5×23 mm Xience™ V stent, Abbott Vascular, Abbott Park, IL) and the distal left main/proximal LAD (4.0×28 mm Xience™ V stent) by use of the mini-crush technique under intravascular ultrasound (IVUS) guidance (iLab® Ultrasound Imaging System, Boston Scientific, Minneapolis, MN). We did final kissing balloon angioplasty and the IVUS showed good apposition and expansion of the two EESs. Coronary angiography showed good left coronary flow and no residual stenosis. However, after removal of the IVUS catheter, there was distal edge damage and shortening of the EES at the LCX (). Because of the patient's consent for the percutaneous treatment, we tried to cross the injured stent lumen with many kinds of wires, but this was ineffective. Therefore, we used a looping wire technique with a 0.014'' hi-torque Balance Middleweight (BMW) universal coronary guide wire (Abbott Vascular) to cross the injured stent and we successfully re-dilated the damaged portion of the stent by using multiple balloons [Ryujin® 1.25 mm (Terumo, Somerset, NJ), Voyager® 2.5 mm (Abbott Vascular), Voyager® 3.5 mm (Abbott Vascular) ()]. Finally, we deployed an additional EES (3.5×18 mm Xience™ V stent, Abbott Vascular) at the LCX over the injured stent. Coronary angiography showed good flow with dye staining at the LCX (). IVUS using the pull-back system from the distal coronary artery showed good expansion and the three EESs were well apposed, except for the partially crushed first-deployed EES of the proximal LCX (). There was no recurrence of chest pain and the patient was discharged from our hospital after intensive medication. The patient has been well during 3 years of clinical follow-up.