In Reply to: Case 497_01 -- Renal stent migration during deployment posted by Editor on April 18, 1997 at 11:19:10:
I referred a difficult case to a more experienced colleague for renal artery stent placement via a brachial artery approach. He hand crimped the Palmaz stent onto a Diamond 5mm by 2cm balloon. In his case the stent migrated proximally off the balloon and onto the shaft of the catheter. He was able to wedge the stent into the guiding catheter and remove the entire system as a unit. The Moral of the story is do not use this balloon for stent deployment, it is too slippery and the coating cannot be removed.
I now only use premounted stents for renal artery stent procedures. I am told that soon the balloon for the pre-mounted stents will be the Cordis Opti-5 which I believe to be an excellent balloon. Following deployment with this balloon, repeat dilation to high pressures will slightly increase the size of this slightly compliant balloon and improve stent implantation into the vessel wall. This should reduce the additional balloon exchange that I currently perform.
Look for an upcoming article by Robert Minor in the Journal of invasive cardiology for a review of his technique.