Surgical Management of a Migrated Coronary Stent in the Lung

A 52-year-old old male was diagnosed with acute coronary syndrome, specifically anterior wall myocardial infarction (MI) with moderate left ventricular (LV) dysfunction, and without congestive heart failure (CCF). He had a history of hypertension, diabetes, and an ischemic cerebrovascular accident (CVA) affecting the right cerebellum, but he exhibited no deficits. A coronary angiogram performed in June 2021 showed single vessel disease (SVD) with left anterior descending (LAD) stenosis. Percutaneous transluminal coronary angioplasty (PTCA) was done in June 2021, and a drug-eluding stent (DES) was placed in the LAD.  

The patient presented again with chest pain in December 2023, with no signs of CCF. An echocardiogram showed no regional wall motion abnormality (RWMA) and mild LV dysfunction. A treadmill test (TMT) was performed, which was negative for exercise-induced ischemia, and he was managed conservatively. 

 In January 2024, he presented with hemostasis. A bronchoalveolar lavage was performed, suggestive of pulmonary infection. The Cartridge-Based Nucleic Acid Amplified Test (CBNAAT) was negative. A computed tomography (CT) scan of the chest was done and showed left lung lingula consolidation, which was managed with antibiotics. 

A CT scan of the chest was performed in December 2025 due to another episode of hemoptysis, which showed left lingula consolidation with a metallic foreign body, likely a migrated coronary stent. A coronary angiogram conducted in December 2025 revealed SVD with chronic total occlusion (CTO) of the LAD artery, with the stent located outside the coronary artery. 

He underwent removal of the migrated stent with coronary artery bypass graft (CABG) with one graft via midline sternotomy, using cardiopulmonary bypass (CPB) with aortoatrial cannulation and antegrade and retrograde cardioplegia. 

The stent was found to have eroded through the pericardium and migrated into the upper lobe of the left lung. No coronary aneurysm or hematoma in the LAD or pericardium was noted during surgery. Dense pericardial adhesions were observed on the left side, and the upper lobe of the lung was adherent to the pericardium. The lung was separated from the heart, and a stapled wedge resection was done with a stent. Postoperative recovery was uneventful.  

The patient is currently asymptomatic post-surgery, with no RWMA and no pericardial effusion on the follow-up echocardiography.  

Extraluminal migration of a coronary stent is an extremely rare complication. To date, only one case report of migration into the right lung from the right coronary artery (RCA) has been reported. 

Possible causes of late stent migration may include damage to the arterial wall resulting from guidewire injury, balloons, stents, infections or inflammatory reactions to DES, which can lead to coronary aneurysm formation and rupture.  

Another hypothesis is that subintimal dissection may have occurred, along with re-entry of the guidewire while crossing the lesion, resulting in partial deployment of the stent in the subintimal space. This could lead to injury of the vessel wall and the subsequent formation of a pseudoaneurysm.  

Over these four years, the stent may have gradually eroded into the lung parenchyma due to repeated friction caused by constant cardiac and respiratory motion. 

References

1. Bhastana VJ, Donepudi BC, Menon RV, Raju BS. The Vanishing Stent: A Rare Case Report of an Extracardiac Migration of a Coronary Stent. JACC Case Rep. 2025 Jun 11;30(14)
2. Quentin de Roux, Sophie Provenchere, Dan Longrois, Christian de Tymowski, Coronary artery stent migration in aorta, Anaesthesia Critical Care & Pain Medicine, 40, 4, (100893).
3. Shashi Ranjan Prasad, R.R. Mantri, A. Mohanty, Extraluminal migration of coronary stents: Report of 2 cases, IHJ Cardiovascular Case Reports (CVCR), Volume 4, Issue 3,2020.
4. Chakraborty P., Isser H., Jahangir A. Asymptomatic, delayed migration of intracoronary stent in pericardial space: a rare phenomenon. JACC Case Rep. 2021;3:5: 745-746

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