Late aortic dislocation of a stent following stent angioplasty for ostial renal artery stenosis

Crimping and repositioning of a maldeployed balloon-expandable arterial stent using a gooseneck snare

PURPOSE

To describe a technique for repositioning a fully deployed iliac stent from the infrarenal aorta into the common iliac artery (CIA).

CASE REPORT

A 58-year-old man was undergoing treatment for a significant right CIA stenosis when a 7x24-mm Palmaz Genesis medium stent was mistakenly deployed in the infrarenal aorta. With the stent still over the guidewire, an 8x60-mm balloon catheter was placed coaxially in the stent. Via a left groin access, a 6-F vascular sheath was introduced retrograde, and a 2.5-cm Amplatz gooseneck snare was advanced into the infrarenal abdominal aorta and pulled back over the stent. The snare was tightly closed to crimp the stent onto the collapsed balloon; this maneuver was repeated several times until the stent was contracted along its entire length. The balloon/stent assembly was carefully pulled back into the right CIA, and the stent was deployed across the target lesion, although there was overlap of the left CIA. Color duplex sonography at 1 year showed no signs of significant iliac arterial stenoses on either side. The patient reported no claudication.

CONCLUSIONS

Using a gooseneck snare, fully deployed balloon-expandable iliac stents can be recrimped on a balloon.