Massive Longitudinal Stent Deformation Due to Jailed Atherectomy Wire

BACKGROUND: Longitudinal stent deformation (LSD) is an uncommon complication during percutaneous coronary intervention that has become more frequent with new drug-eluting stents. CASE SUMMARY: We present a case of massive LSD caused by withdrawal of a jailed RotaWire. We could not cross the deformed stent using chronic total occlusion small-balloon and guide-catheter extension support, which left us with a bailout rotational atherectomy through the freshly implanted deformed stent. This resulted in a second complication, namely a burr entrapment. DISCUSSION: Jailing a RotaWire should always be avoided, and when it inadvertently occurs, wire extraction should be carefully tried after advancing a microcatheter or with predilatation using very small balloons. Once LSD occurs, a stepwise algorithm should be followed to avoid further complication escalation. TAKE-HOME MESSAGE: This case underscores the importance of LSD as a complication during percutaneous coronary intervention and rotational atherectomy; it highlights the possible mechanisms and how to approach it.