Perkütan Koroner Girişimlerde Stent Sıyrılması: Mekanizmalar, Yönetim Stratejileri ve Vaka Örnekleri
Özet
Stent sıyrılması (stent stripping / stent dislodgement), perkütan koroner girişim (PKG) sırasında nadir ancak hayatı tehdit edebilen ciddi bir komplikasyondur. Kalsifik, kıvrımlı ve uzun lezyonlarda karşılaşma sıklığı daha yüksektir. Stentin balondan ayrılması; periferik embolizasyon, tromboz ve akut kardiyak olaylarla sonuçlanabilir. Bu bölümde stent sıyrılmasının epidemiyolojisi, risk faktörleri, sınıflandırması, tanı ve tedavi algoritmaları ile kurtarma teknikleri ayrıntılı biçimde ele alınmaktadır. İleri kalsifikasyonlu sağ koroner arterde predilatasyon sonrası oluşan iatrojenik diseksiyonun eşlik ettiği stent sıyrılmasını anlatan özgün vakamızda; mikro snare ile kurtarma girişimi başarısız olmuş, akabinde diseke hattan yeni tel geçirilerek stent lümene başarıyla gömülmüştür. Bu teknik, benzer komplikasyonlarda uygulanabilecek pratik bir kurtarma seçeneği olarak sunulmaktadır.
Stent loss (stent stripping or stent dislodgement) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). It occurs more frequently in heavily calcified, tortuous, and long coronary lesions and may result in peripheral embolization, coronary thrombosis, or other acute cardiovascular events. This chapter comprehensively reviews the epidemiology, risk factors, classification, diagnostic approach, management algorithms, and percutaneous retrieval techniques for stent loss. We also present an original case of stent loss complicated by iatrogenic coronary artery dissection following predilatation of a severely calcified right coronary artery. Conventional retrieval using a micro-snare was unsuccessful because of the associated dissection. Subsequently, a new guidewire was advanced through the dissected lumen, and the dislodged stent was successfully crushed against the vessel wall with additional stent implantation. This bailout technique may represent a practical therapeutic option for selected cases in which conventional retrieval strategies fail.
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