CathLabHub

CathLabHub complications toolkitcathlabhub.com/toolkit/stent-lossIn review, October 24, 2026

Recognize

The signs on the monitor, the image and the patient.

  • ImageThe stent markers separate from the balloon markers, or a stent is left behind in the guide, the vessel or the aorta on withdrawal 1.
  • ImageA stent that will not cross a calcified or tortuous bend and comes back deformed 1.
  • ImageThin strut stents can be hard to see; IVUS finds a stent fluoroscopy misses 1.
  • MonitorIschemia or a drop in flow if the stent obstructs the vessel.

Act now

In the order the operator does them. The first three come first, whatever else is happening.

  1. Do not pull the wire; wire position through the stent is what makes retrieval or deployment possible 1.
  2. Locate the stent: coronary, guide, aorta or a peripheral artery 1.
  3. Decide if it must come out: yes in the left main, a major bifurcation or the cerebral or renal arteries; often no in a noncritical coronary or leg location 1.
  4. Wire still through it: small balloon technique, a 1.5 mm balloon passed through and inflated distal to the stent at low pressure, then pulled back together 12.
  5. Wire lost: a loop snare (coronary snares of 2, 4 or 7 mm), or two wires twirled together to entangle it 1.
  6. If retrieval fails, reassess: deploy the stent with balloons of increasing size, or crush it against the wall with another stent 1.
  7. Peripheral location that is not critical: leave it or crush it with a peripheral stent 1.
  8. Surgery only under extenuating circumstances; it carries high risk 1.

Equipment

From the complications cart. Linked items open in the equipment directory.

  • Small coronary balloons1.0 to 1.5 mm for the small balloon technique 2. Directory: Sapphire II Pro 1.0, Trek and Mini Trek.
  • Coronary loop snares0.014 inch snares with 2, 4 or 7 mm loops; 2 or 4 mm multi loop snares 1.Not in the directory yet.
  • Large three loop snare for the aorta and periphery18 to 30 mm loops through a JR4 or multipurpose catheter 1.Not in the directory yet.
  • Bioptome or retrieval forcepsFor a stent in a large proximal vessel 2.Not in the directory yet.
  • Guide extension and a trapping deviceDirectory: GuideLiner V3, TrapLiner.
  • IVUSTo find the stent and confirm apposition after crushing 1. Directory: Eagle Eye Platinum.
  • Peripheral stent for crushing in the iliac or femoral arteryDirectory: Omnilink Elite.

Drugs

Adult doses as the cited source gives them. Check your formulary and the label.

Who to call

The escalation ladder, first call first.

  1. Second operator: to hold the guide and wire while you snare.
  2. Interventional radiology: for a stent in a peripheral artery that must come out.
  3. Cardiac surgery: for a stent in the left main that cannot be retrieved or deployed 1.

The bailout step by step

Small balloon technique 12

  1. Keep the wire through the lost stent.
  2. Advance a low profile 1.0 to 1.5 mm balloon over the wire through the stent 2.
  3. Inflate it just distal to the stent at low pressure, 1 to 2 atm 2.
  4. Pull the balloon back gently; the stent comes with it.
  5. If the stent enters the guide, remove everything; if it is too deformed, pull the guide, balloon and stent out together as one unit 1.
  6. If the balloon only reaches the proximal stent, inflate it there and withdraw the system 1.
  7. If the stent moves distally instead, switch to deployment or crushing 1.

Prevent

  • Prepare calcified lesions before stent delivery; avoid direct stenting in tortuous calcified vessels 1.
  • Do not pull a stent back forcefully into the guide or a guide extension 1.
  • Avoid 5 Fr guides for complex lesions; a deformed stent needs room 1.
  • Stent distal to proximal 1.

After care and documentation

  • Image the final result if a stent was deployed or crushed 1.
  • Document the stent, where it was lost, how it was treated, and keep the device for analysis.
  • Report the device event through your device reporting process.

Practice

Emergency simulator cases in the Cath Trainer app. The link opens Cases; type the case number in the search box.

  • EMG-0026: The stent will not cross a calcified bend
  • EMG-0051: Trouble delivering a stent through a tortuous vessel

References

  1. Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 27, Equipment loss and entrapment.
  2. Berg R, Lim MJ. Complications of percutaneous coronary interventions. In: Kern MJ, ed. The Interventional Cardiac Catheterization Handbook. 3rd ed. Saunders, Elsevier; 2013. Chapter 4.
  3. Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 25, Acute vessel closure.
  4. Brilakis ES. Manual of Percutaneous Coronary Interventions: A Step-by-Step Approach. Academic Press, Elsevier; 2021. Chapter 3, Medications.
  5. CathLabHub Cath Trainer app, emergency simulator: case library (cathlabhub.com/app, Cases).

Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/stent-loss. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.