Stent dislodgement: a rare complication of subclavian artery aangioplasty and stenting.

Dear Editor,

A 69-year-old female on hemodialysis was admitted to a hospital with severe pain in her left arm with the use of brachiocephalic fistula. An angiogram was done for evaluation of the pain, and it showed subclavin artery occlusion. Vascular surgery recommended a subclavian artery angioplasty with stenting. During the procedure, the stent was inadvertently deployed in the brachial artery and multiple attempts were made to retrieve the stent using a snare, but these were not successful [Figure 1]. The patient was immediately taken to the operating room and a cut down was performed at the level of brachial artery in order to remove the stent. The artery was repaired with bovine patch graft. There were no complications in the post-operative period.

Figure 1

During the procedure, the stent was inadvertently deployed in the brachial artery and multiple attempts were made to retrieve the stent using a snare, but these were not successful

Stent dislodgement is a rare complication of such procedures. There are no reported incidences of this complication. Stent dislodgement can potentially lead to vascular occlusion, thrombosis, and limb ischemia. Primary stent deployment in an occlusive subclavian artery disease is a safe procedure with reported success rate of 100%.[1] In a case series between 1998 and 2005 on 26 patients undergoing stenting for chronic subclavian artery occlusion, two patient had stent migration during the procedure.[2] Stenting of subclavian artery lesions results in immediate resolution of patients’ symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions;[3] however, not much is known about stent dislodgement incidence and its management. Our case serves to highlight this complication of endovascular procedure and provides a management strategy.