Left Main Coronary Artery Stent Migration
A 22-year-old woman with primary pulmonary hypertension presented with displacement of stents that had been implanted in the left main coronary artery and had migrated into the aorta (Panel A). She had been referred to our center for evaluation for lung transplantation. Her initial presentation to the referring hospital, more than 12 months earlier, had included recurrent chest pain and fainting spells. An angiogram was obtained at that time and showed stenosis of the left main coronary artery that was probably due to external compression from an enlarged pulmonary artery (Panel B). The patient underwent percutaneous coronary intervention, and two drug-eluting stents, measuring 8 mm×4 mm and 4 mm×4 mm, were placed (Panel C). The likely cause for the current presentation of displacement of these stents was compression from the enlarging pulmonary artery, with pulmonary-artery pressures close to 120 mm Hg. Given the complexity of the lesions and the location of the stents, it was decided that removal of the migrating stents and further angioplasty of the lesions presented undue risk. The patient was listed for combined heart and lung transplantation, which she subsequently received. At follow-up 1 year after transplantation, she was doing well.
