Failed coronary stent deployment

Background Coronary stent deployment failure may be more common in clinical practice than generally appreciated. The incidence of failed deployment in routine clinical practice and the clinical sequelae have not been describe d. This study sought to determine the incidence and consequences of foiled coronary stent deployment and to identify clinical and angiographic charact eristics associated with deployment failure. Methods and Results A series of 1303 consecutive procedures involving attem pted coronary stenting were reviewed retrospectively Failed stent deploymen t was defined as failure of the stent to be either delivered to or adequate ly deployed at the target lesion site. Clinical records and angiograms were reviewed and qualitative coronary angiography was performed for all cases of failed deployment. Deployment was unsuccessful in 108 (8.3%) cases invol ving 134 stents. Stenting was attempted as a primary procedure in 40%, as b ailout in 13%, and for suboptimal angioplasty in 43% of cases. In 87% of ca ses, attempts were made to withdraw the stent from the coronary artery. Ste nt retrieval was successful in 45%, peripheral embolization occurred in 38% of patients, and in 4% the stent dislodged in the left main artery. In 35% of cases, additional stent(s) were successfully deployed. Deployment failu re was associated with an overall in-hospital adverse out come in 19% of pa tients, including 16% urgent coronary artery bypass grafting, 5% nonfatal m yocardial infarction, and 3 in-hospital deaths. At 6-month follow-up, 39% o f patients had had at least 1 adverse clinical outcome of death, myocardial infarction, or repeat target lesion revascularization. Conclusions Failure to deploy stents is a serious and relatively common pro blem that is associated with significant morbidity and mortality rates. Imp roved deployment strategies, including new stent designs, are required to i mprove procedural outcomes.