[Coronary wire entrapment and unintended extraction of a just deployed stent]

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Device Technology

Background:

• Unstable angina necessitates prompt intervention, often involving percutaneous coronary intervention (PCI) for complex coronary artery lesions.
• Bifurcation lesions, particularly those involving the left main coronary artery and its branches, present significant technical challenges during PCI.
• Left dominance systems add complexity to coronary interventions due to anatomical variations.

Observation:

• A 53-year-old male presented with unstable angina due to subocclusive stenosis in the ostial-proximal intermediate branch of a left dominant system.
• An ad hoc PCI was performed on a Medina 0,0,1 bifurcation lesion involving the left main and left anterior descending (LAD) arteries.
• During guidewire removal after stent deployment, wire entrapment in the LAD occurred, leading to accidental dislodgement of the deployed drug-eluting stent.

Findings:

• Initial PCI involved pre-dilation and deployment of a 3.0/22 mm drug-eluting stent in the intermediate branch, with a "safety balloon" protecting the LAD.
• Wire entrapment in the LAD during guidewire removal necessitated managing the complication before proceeding.
• A second PCI successfully deployed a 3.25/23 mm drug-eluting stent in the intermediate branch after re-advancing a guidewire in the LAD.

Implications:

• This case highlights a rare complication during PCI of complex bifurcation lesions, emphasizing the need for meticulous technique and preparedness.
• Effective management of guidewire entrapment and stent dislodgement is crucial for successful outcomes in challenging coronary interventions.
• Discussion of technical aspects may inform strategies for preventing and managing similar complications in interventional cardiology practice.