When the Shaft Breaks: Managing a Cath Lab Nightmare

We describe the case of a 57-year-old male patient with anterior ST-segment elevation myocardial infarction in cardiogenic shock. Coronary angiography revealed severe left main (LM) and triple-vessel disease, and the patient was refused for surgery due to lack of distal grafting landing zone. A shaft fracture occurred during LM percutaneous coronary intervention, leaving the fractured stent hanging in the aorta. This case highlights the successful retrieval of the fractured stent shaft using a snare technique.Key steps include coronary protection and bailout fixing with a stent in LM artery and use of snare technique to retrieve the shaft from the aorta.

Operators should avoid pulling the system when stent entrapment occurs.

Bailout access through the Impella sheath can be used in complication management. When stent entrapment occurs, use balloon trapping instead of pulling the entire system and protect coronary arteries with guidewires before proceeding with shaft extraction.