Dislodgement of Balloon Expandable Stent Graft in Aortic Coarctoplasty, Protector or Proctor Fault?: A Case Report

Introduction: Coarctation of the aorta is a congenital narrowing of the thoracic aorta associated with hypertension and significant pressure gradients across the coarctation site. Coarctoplasty by percutaneous approach is the preferred method of treatment. However, complications like stent dislodgement may result and must be immediately managed to prevent adverse outcomes.

Case Presentation: A 29-year-old male, who had previously undergone a mitral valve replacement, presents with exertional dyspnea and systemic hypertension. Blood pressure measurements revealed a 50 mmHg gradient between the upper and lower extremities. Imaging modalities revealed severe CoA with a 45 mmHg peak systolic gradient. During percutaneous coarctoplasty with a balloon-expandable stent, improper use of the yellow applicator resulted in stent dislodgment. A stent was partially deployed and, after post-dilation, the stenosis was resolved. The patient recovered uneventfully and remained asymptomatic with no evidence of recoarctation at six-month follow-up.

Discussion: Coarctoplasty with stent implantation is a relatively safe yet effective treatment for CoA. However, this technique may be complicated by stent dislodgment due to technical error or device-related issues. The major cause of stent dislodgment in the present case was considered failure to use the yellow applicator. Fortunately, prompt corrective measures allowed uneventful deployment of the stent without major complications.

Conclusion: Strict adherence to procedural protocols is critical for minimizing complications and achieving optimal outcomes on CoA interventions.