Stent Crush Bailout for a Deformed Stent Nodule Caused by Entrapped Guidewire Extraction: A Case Report

TL;DR

A case report describes a complex coronary intervention in an elderly patient with severe artery disease and a rare complication involving a trapped guidewire and stent deformation.

Contribution

This case highlights the role of intravascular imaging in managing a rare complication during high-risk bifurcation PCI.

Findings

A trapped guidewire caused stent deformation during PCI in a heavily calcified bifurcation.

Intravascular ultrasound was crucial for confirming wire position and stent apposition.

The patient had successful outcomes with TIMI 3 flow and no side-branch compromise.

Abstract

We report the case of an 82-year-old man with end-stage renal failure and complex coronary artery disease who underwent percutaneous coronary intervention (PCI) for severe calcified stenosis in the left main trunk and proximal left anterior descending artery. Given the heavily calcified nature of the lesion, rotational atherectomy (Rotablator, Boston Scientific, Marlborough, MA) was performed. A provisional stenting strategy was employed with side-branch wire protection. Protected hydrophilic-coated guide wire (Runthrough NS Ultra Floppy; Terumo, Tokyo, Japan) entrapment likely occurred due to wrapping around stent struts during proximal optimization technique (POT) in a heavily calcified bifurcation, resulting in stent deformation upon attempted wire withdrawal. Intravascular ultrasound played a crucial role in confirming wire position, stent deformation, and post-fenestration stent apposition. Final angiography demonstrated TIMI (Thrombolysis in Myocardial Infarction) 3 flow with no side-branch compromise, and the patient remained asymptomatic post-procedure. This case highlights the importance of meticulous technique and intravascular imaging guidance in high-risk bifurcation PCI.

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