Guidewire Traction Retrieval of a Dislodged Classic Crown During Coronary Orbital Atherectomy

BACKGROUND Heavily calcified coronary lesions often lead to stent underexpansion and procedural complications. Treatment comprises plaque modification techniques, such as atherectomy. Orbital atherectomy (OA) is effective for preparing severely calcified lesions prior to stenting. Device-related complications, including crown detachment, are rare but potentially serious. CASE REPORT A 70-year-old man with stable angina and 90% proximal right coronary artery stenosis displayed concentric, heavy calcification on intravascular ultrasound. OA was performed using the Diamondback 360 Orbital Atherectomy System (Classic Crown), initially at low speed (80 000 rpm). During the procedure, the crown and part of the driveshaft became dislodged and remained within the artery, although the patient remained stable. A buddy wire was advanced past the detached crown to secure distal access. Retrieval attempts with an Amplatz Goose Neck snare and an anchor-balloon technique using a Telescope guide extension catheter were unsuccessful. Ultimately, the crown was retrieved by gently applying traction to the ViperWire Advance Flex Tip guidewire, pulling it into the guide catheter. The lesion was then stented with a drug-eluting stent and optimized via postdilation. Final angiography showed excellent results, and the patient recovered uneventfully. CONCLUSIONS This case highlights a rare OA complication and demonstrates a successful percutaneous bailout strategy. When crown detachment occurs, retrieval using guidewire traction may be effective if standard techniques fail, potentially avoiding emergency surgery. Operators should remain vigilant for device fracture and be prepared with multiple retrieval options.