If I Have Heart Stents Can I Have an Mri Three Months Aftet
Introduction
Several studies have shown the condom of MRI afterward coronary stenting; however, few of them included patients before long after stenting. In this report, we draw a instance of MRI-induced stent dislodgment from left main coronary artery (LMCA) ii weeks after stenting.
Case Report
A 56-twelvemonth-quondam woman underwent coronary angiography for recurrence of angina 12 months after coronary artery bypass graft surgery. Coronary artery bypass graft surgery had been performed with left internal mammary artery grafted to left anterior descending avenue and a saphenous vein graft to obtuse marginal co-operative for LMCA stenosis (Figure 1). The comorbidities of patient included hypertension, dyslipidemia, diabetes mellitus, and prior neurosurgery for a pituitary adenoma. The repeat angiogram showed known stenosis in LMCA, nonobstructive disease of left anterior descending artery and right coronary avenue, patent saphenous vein graft to obtuse marginal co-operative, and an occluded left internal mammary artery (Effigy ii). Afterwards give-and-take, stenting of the LMCA with a iii.five×8 mm drug-eluting stent (Goose egg; Cordis Corp, Markham, Ontario) was deployed after predilatation under intravascular ultrasound guidance (Effigy iii).
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Figure ane. Baseline coronary angiography. Baseline coronary angiography showing a significant and eccentric left chief coronary artery (LMCA) stenosis (A) that was managed by surgical revascularization. Right coronary artery showed no pregnant plaque (B). Arrowhead indicates stenosis in the LMCA.
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Effigy two. Echo coronary angiography with intravascular ultrasound of the left main coronary avenue. Repeat coronary angiography 12 months afterwards coronary artery bypass graft surgery showed previously known stenosis of left main coronary artery (LMCA; arrowhead), nonobstructive illness of left anterior descending artery and circumflex (A), small plaque of the right coronary avenue (B), patent vein graft to obtuse marginal branch (C), and occluded left internal mammary avenue graft (D). Intravascular ultrasound of LMCA (East) confirmed an eccentric plaque with significant stenosis (minimal lumen diameter, 2.five mm; minimal lumen area, 5.1 mm2). C indicates intravascular ultrasound catheter; line with 2 arrowheads, minimal lumen diameter; and P, eccentric plaque.
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Figure three. Follow-upwards coronary angiography with stenting of the left primary coronary artery under intravascular guidance. PCI of the left principal coronary artery (LMCA) with drug-eluting stent that was postdilated with a noncompliant balloon with excellent angiographic result (A–Due east). Intravascular ultrasound (IVUS) images showed advisable stent sizing, adequate and symmetrical expansion (F), and stent struts extending proximal to the ostium of LMCA in cross-sectional (M) and longitudinal views (H). Arrowheads betoken stent struts extending proximal to the ostium of LMCA; C, IVUS catheter; PCI, percutaneous coronary intervention; and S, stent struts. *Well-expanded stent struts with skilful apposition to the vessel wall (minimal lumen diameter, iv mm).
The patient underwent MRI of the caput in a 1.5-Tesla scanner for surveillance of pituitary pathology 2 weeks after stenting. Follow-up angiography (Figure 4) was performed to investigate the symptoms of chest pain and assess stent patency. The implanted stent could non be visualized in the LMCA on angiography, and an intermediate residual stenosis was observed. A whole-body screening computed tomography was performed to locate the missing stent that was successfully identified in the proximal branch of the left iliac artery (Figure 5). In the absence of symptoms for arterial insufficiency, no attempt was made to retrieve the embolized stent. Normal perfusion on repeat nuclear imaging confirmed that residual LMCA stenosis was non hemodynamically significant, and patient was continued on medical therapy with no clinical events occurring during long-term clinical follow-up.
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Figure iv. Follow-up coronary angiogram afterwards MRI. Follow-upward coronary angiogram showed absenteeism of previously implanted stent (A) and an intermediate residual stenosis in the left main coronary avenue (B). Arrowheads indicate previously stented segment.
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Effigy 5. Noncontrast computed tomography of abdomen and pelvis showing dislodged stent. A whole-body noncontrast computed tomography identified the dislodged stent in the proximal part of left internal iliac avenue (arrowheads). The stent location is shown in transverse (A), coronal (B and C), and sagittal planes (D).
Discussion
To our knowledge, this is the beginning report of coronary stent dislodgment related to an MRI procedure. Although the clinical implications of stent dislodgment can be serious, fortunately no adverse consequences were observed in this instance as the stent migrated to a peripheral vessel in pelvis, an area with significant collateral circulation.
Safety of MRI Subsequently Coronary Stenting
Careful screening of patients undergoing MRI is mandated in patients with metallic objects and implants.ane To amend condom, all implant devices are classified every bit MR safe, MR conditional, or MR unsafe based on the run a risk posed in strong magnetic fields. The stents are composed of metal alloys, such as stainless steel, tantalum, nitinol, cobalt, titanium, chromium, and nickel, which are weak ferromagnetic metals and classified equally MR conditional, which ways that there is no known hazard in a specified MR environment within standard use. The currently available stents are predominantly made of 316 low-carbon stainless steel (316L) and titanium. Steel 316L contains nickel (10%–fourteen%) that diminishes the occurrence of ferromagnetism. Factors influencing the risk of MRI with metal implants are (1) strength of the static magnetic field, (2) gradients of the magnetic field, (iii) degree of ferromagnetism, (4) geometry of device, and (5) the location and orientation of the implant in situ during MRI.ii Several studies have reported on the safety of i.5- to 3-Tesla MRI for coronary stents, only few included patients soon after stenting.three
Potential Mechanism of Stent Dislodgment After MRI
Despite the demonstrated safety of MRI for most patients with coronary stents, we propose careful take a chance assessment. A brusque stent at an aorto-ostial location, use of drug-eluting stent with delayed endothelial coverage, and a brusque fourth dimension of MRI subsequently stenting are high-risk features for an adverse issue in a strong magnetic field.
Conclusions
The available evidence supports the safety of MRI later coronary stenting in general. However, careful take a chance assessment should be undertaken for an individual patient with regard to the type and location of stents and the timing of MRI after stenting.
Footnotes
References
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Source: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.112.000790
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