Bailout Endovascular Retrieval of a Severely Kinked Guiding Catheter During Primary PCI for Inferior STEMI

Guiding catheter kinking during primary percutaneous coronary intervention (PCI) is a rare but potentially hazardous complication that may result in vascular injury or procedural failure if not properly managed. A 75-year-old male with chronic kidney disease on maintenance hemodialysis via arteriovenous fistula presented with inferior ST-segment elevation myocardial infarction and underwent emergent primary PCI via femoral access. During right coronary artery engagement with a 7 F guiding catheter, severe double-segment kinking developed. Wire-assisted correction failed, and further manipulation led to pronounced deformation with extension toward the left subclavian artery. Considering the need to preserve upper extremity arteries in a dialysis patient, a contralateral femoral access was preferred for bailout management. A macro snare was used for distal stabilization, and controlled counter-traction enabled progressive straightening and safe catheter retrieval without vascular injury. A new guiding catheter was subsequently introduced, and successful revascularization of the totally occluded right coronary artery was achieved. This case highlights the importance of structured snare-assisted realignment and access-site selection in managing severe catheter deformation during time-critical PCI.