In Reply to: Case 497_01 -- Renal stent migration during deployment posted by Editor on April 18, 1997 at 11:19:10:
This is the nightmare I worry about every time I do a renal. I have been routinely primarily stenting renals with Palmaz stents, unless I cannot get it to cross the first time, then will dilate with a balloon followed by the stent. I worry about extending a flap into a branch vessel - most likely a nonsalvagable senario. Anyone seen this? Am I worried about something that just doesn't happen in reality?
As far as I can tell you didn't use a guiding catheter. I preload a hand-crimped Palmaz on a PEMT into an 8F guiding catheter, and load the whole works through an 8F groin sheath. The thought is that if the stent spits back onto the balloon shaft I can pull the whole deal out and maintain access across the lesion (and have had to do this 2 or 3 times!). If the stent spits forward the balloon can be removed and a snare place through the guiding catheter. However, without an appropriate Touhy-Borst device there is back bleeding.
This only requires a slight upsizing in the groin puncture, though it can be a bit clumsy with all of the stuff to deal with (wire, balloon, guiding catheter, sheath).
BTW, I use PEMT due to supply constraints at my hospital, though the Olbert may be the answer, and a lot easier.