Stent loss and retrieval during percutaneous coronary interventions: A systematic review and meta-analysis

Objective: We present a systematic review and meta-analysis of the frequency, consequences, and treatment of stent loss during percutaneous coronary intervention (PCI). Background: Stent loss during PCI has received limited study. Methods: We conducted a meta-analysis of 18 case series and 45 case reports published between 1991 and 2012 on stent loss during PCI. Data on the frequency of stent loss, treatment strategies, and clinical outcomes were collected. Results: A total of 1048 stents were lost in 968 PCIs. Stent loss occurred in 919 of 71,655 PCIs (1.3%; 95% confidence interval, 0.8%-2.8%). The incidence of stent loss in studies published before 2000, between 2000 and 2005, and after 2005 was 5%, 1%, and 0.3%, respectively (P<.001). Of the 1048 lost stents, 698 (66%) were successfully retrieved from the coronary circulation, 130 (12%) were deployed, 27 (3%) were crushed, and 28 (3%) were left untreated; treatment of 165 stents (16%) was not reported. A complication occurred in 171 patients (19%), of whom 98 (57%) had coronary artery bypass graft surgery, 31 (18%) myocardial infarction, 33 (19%) died, 10 (6%) had bleeding requiring transfusion, 5 (3%) had vascular access complications, and 1 patient (0.6%) had a cerebrovascular accident (some patients had more than one event). Conclusions: The incidence of stent loss during PCI is low and has been decreasing. Although the lost stents were successfully retrieved in most cases, stent loss was associated with high rates of complications, such as coronary artery bypass graft surgery, myocardial infarction, and death.