Inadvertent extraction of a deployed stent after using twisted wire technique

Stent dislodgement prior to deployment is a rare complication during percutaneous coronary intervention (PCI). The incidence has gradually decreased because of the utilization of premounted stents [1]. However, stent dislodgement after deployment is a more uncommon complication [2e5]. We report a case of stent dislodgement after using a twisted wire technique. A 61-year-old male suffered from dyspnea and was brought to our emergency department (ED). Electrocardiography revealed ST depression over inferior and lateral leads, and the patient was intubated because of pulmonary edema. Laboratory data showed elevated cardiac enzymes. An early PCI was arranged, and angiography showed the middle right coronary artery with 95% stenosis and the left circumflex artery (LCX) with severe diffuse lesions. First, the right coronary artery was simply treated with angioplasty and stenting. Then the lesions of LCX were predilated by angioplasty, and a 2.5 mm 24 mm stent was deployed over the distal LCX. We further deployed a 2.75 mm 28 mm stent over the proximal LCX. Because there was an uncovered lesion between the stents, we decided to cover it with a 2.75 mm 15 mm stent. However, we failed to cross the LCX because of the proximal deployed stent and angulation. The unexpanded stent was entrapped and dislodged over there. Because the guidewire was still in situ, we used the twisted wire technique to retrieve the stent. A Whisper guidewire was selected to cross the LCX, and two wires were rotated several turns. A significant resistance was felt while pulling back the dislodged stent. After several attempts, we finally pulled out the dislodged stent; however, a