When Subtle Guiding Catheter-Induced Stent Deformation Leads to Abluminal Guidewire Passage: Successful IVUS...

Incomplete stent apposition at the proximal coronary artery may predispose to subtle guiding catheter-induced stent deformation, creating a gap between the stent and the vessel wall that facilitates inadvertent abluminal guidewire passage. We report a case in which balloon dilatation over an unrecognized abluminal guidewire resulted in severe proximal stent deformation and was successfully managed by real-time IVUS tip-detection-guided rewiring into the true stent lumen, avoiding additional stent implantation. This case highlights the importance of careful guiding catheter manipulation, meticulous intravascular imaging assessment after guidewire crossing, and IVUS-guided bailout techniques for the prevention, early recognition, and management of this potentially serious procedural complication.