Newer generation self-expandable coronary stent bail-out re-sheathing

Newer generation of self-expandable nitinol coronary stents has proven to be useful in the treatment of bifurcations, tapered vessels, thrombotic lesions, venous grafts and ectatic segments. However, optimal device positioning can be cumbersome, due to the peculiar delivery mechanism which consists of retracting an outer sheath in order to release the stent from the distal edge. We report the case of a 53-year-old man, admitted for unstable angina. Coronary angiography showed a tight stenosis of the proximal left anterior descending coronary artery. As the lesion was located in an ectatic segment of the vessel, we chose to implant a StentysTM (Stentys S.A., Paris, France) device. During the release, the stent jumped forward, resulting in geographic miss. We describe the technique used to retrieve the stent and how we re-deployed it in the proper position; moreover, we examine the lesion characteristics which fostered the migration of the self-apposing stent along the vessel.