When Subtle Guiding Catheter‐Induced Stent Deformation Leads to Abluminal Guidewire Passage: Successful IVUS Tip‐Detection‐Guided Bailout

ABSTRACT 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.