Complications Following Retrieval of an Embolized Guide Catheter Tip Following Left Main Bifurcation PCI

A 59-year-old woman presented with non-ST-segment elevation myocardial infarction. Angiography showed severe 3-vessel coronary disease. Percutaneous coronary intervention was successfully performed. We noted a circular opacity in the mid left anterior descending, representing the radio-opaque tip of the guide catheter. Multiple guidewires were entangled around the guide tip to drag it back to the guide. The entrapped tip caught on the circumflex (Cx) stent at the neo-carina. When this was pulled back toward the guide catheter, the deployed left main-Cx stent involuted, elongated, and came back into the aorta. Surgical repair was performed with an aortic dissection. Coronary bypass grafts were anastomosed to the left anterior descending artery and Cx. The patient was discharged home well 5 days later. This case represents a rare complication of percutaneous coronary intervention. If operators are faced with a similar complication they should consider using a guide catheter extension through the already deployed stents. Large-bore femoral access should be considered.