Percutaneous Coronary Stentectomy: Redefining Stent Failure Management in the Modern Era

Percutaneous coronary stentectomy, intentional retrieval of a fully deployed coronary stent, has evolved from anecdotal salvage to a structured interventional strategy. It addresses scenarios where a deployed stent causes ongoing complications: malapposition, longitudinal deformation, or excessive aorto-ostial protrusion leading to restenosis, thrombosis, or interference with structural heart interventions. We performed a narrative review of the published literature on intentional percutaneous coronary stent retrieval, supplemented by five illustrative cases from three academic centers representing acute, subacute, and late retrieval scenarios. Stentectomy was feasible across acute and late settings. Snare-based retrieval through guide extension catheters was the predominant approach; stents with three or fewer inter-ring connectors allowed more predictable extraction. Intravascular ultrasound was essential for procedural planning, confirmation of complete removal, and post-extraction management. Drug-coated balloons enabled metal-free revascularization after stent removal. A novel reverse hairpin-assisted snare extraction technique facilitated pre-TAVR stent retrieval in one case. The Side Flap technique and stentectomy emerged as complementary strategies for managing excessive aorto-ostial protrusion. Percutaneous coronary stentectomy is a feasible strategy for selected clinical scenarios, with intravascular imaging central to procedural planning and assessment. When performed with appropriate technique and Heart Team evaluation, it can address stent complications, restore coronary access, and enable metal-free revascularization.