From the Guidelines
Stent migration is a significant complication that can lead to serious consequences, including obstruction, perforation, bleeding, or complete failure of the stent's therapeutic purpose, and therefore, immediate medical attention is necessary if suspected. This displacement can occur in any type of stent, including coronary, biliary, ureteral, or esophageal stents, and the risk varies depending on stent design, placement technique, and patient anatomy 1. The symptoms of stent migration depend on the stent location but may include pain, bleeding, recurrence of original symptoms, or new obstructive symptoms.
Some key points to consider in the management of stent migration include:
- Proper stent selection based on anatomy to minimize the risk of migration
- Secure anchoring techniques during placement to ensure the stent remains in position
- Regular follow-up imaging to monitor the stent's position and detect any potential migration early
- Immediate intervention to retrieve or reposition the stent if migration is suspected, which may involve endoscopic or surgical procedures
According to the most recent evidence, the long-term patency of stents placed for nonthrombotic iliac vein lesions (NIVL) ranges from 96% to 99%, as observed in multicenter cohorts 1. However, stent migration can still occur, and it is essential to be aware of the potential risks and complications associated with stent placement.
In terms of specific guidelines, the consensus statement on the management of NIVL recommends routine early and long-term clinical surveillance, including imaging of patients with NIVL following stent placement, to assess for stent-related adverse events such as migration and stenosis/thrombosis 1. This highlights the importance of regular monitoring and follow-up in patients with stents to detect any potential complications early and prevent serious consequences.
From the Research
Significance of Stent Migration
- Stent migration is a rare but serious and potentially life-threatening complication that can occur after stent placement [(2,3,4,5,6)].
- It can lead to damaged valves, arrhythmias, endocarditis, tamponade, and acute heart failure 3.
- Stent migration can be attributed to incorrect stent and/or vein sizing, as well as the inherent natural forces of the body during respiration 3.
- The risk of migration is rare but might be underreported, with most reported cases occurring with shorter and smaller diameter stents 4.
Consequences of Stent Migration
- Stent migration can result in serious complications, including death, as reported in a case where a patient expired in the emergency department 2.
- It can also lead to severe tricuspid regurgitation and other circulation issues 3.
- Stent retrieval can be difficult and must consider the location of the migrated stent and the comorbidities associated with the patient 3.
Prevention and Management of Stent Migration
- Intravascular ultrasound (IVUS) should be utilized for proper vein and stent sizing prior to placement to prevent migration 3.
- Patients should be monitored more closely after the procedure to detect any potential complications 3.
- Various techniques are available to bail out interventionalists if stent migration occurs, including a wait and watch approach 5.
- Surgical management may be necessary in some cases, such as partial removal of the migrated stent through aortotomy along with surgical revascularization 6.