Stent Crush Bailout for a Deformed Stent Nodule Caused by Entrapped Guidewire Extraction: A Case Report

We report the case of an 82-year-old man with end-stage renal failure and complex coronary artery disease who underwent percutaneous coronary intervention (PCI) for severe calcified stenosis in the left main trunk and proximal left anterior descending artery. Given the heavily calcified nature of the lesion, rotational atherectomy (Rotablator, Boston Scientific, Marlborough, MA) was performed. A provisional stenting strategy was employed with side-branch wire protection. Protected hydrophilic-coated guide wire (Runthrough NS Ultra Floppy; Terumo, Tokyo, Japan) entrapment likely occurred due to wrapping around stent struts during proximal optimization technique (POT) in a heavily calcified bifurcation, resulting in stent deformation upon attempted wire withdrawal. Intravascular ultrasound played a crucial role in confirming wire position, stent deformation, and post-fenestration stent apposition. Final angiography demonstrated TIMI (Thrombolysis in Myocardial Infarction) 3 flow with no side-branch compromise, and the patient remained asymptomatic post-procedure. This case highlights the importance of meticulous technique and intravascular imaging guidance in high-risk bifurcation PCI.