Case 222: Manual of CTO PCI - Stent loss in donor vessel

A patient was referred for PCI of non-occlusive lesions in the LAD and diagonal and a right posterolateral CTO. When connecting the LAD stent balloon to the indeflator, the balloon inadvertedly inflated deforming the proximal part of the stent that could not be delivered to the target lesion. During attempts to retrieve the stent, it came off the balloon. The small balloon technique failed to retrieve the lost stent due to stent deformation. Using a 2-4 mm Ensnare the lost stent was retrieved along with the LAD guidewire. The LAD was rewired and successfully stented. The right posterolateral CTO was successfully crossed using the BASE technique and Stingray reentry with an excellent final result.

[@mahmoud_elrayes]

Excellent case. What is your view regarding use of guide extension during small balloon retrieval technique to prevent injury of LM & proximal LAD by proximal stent edge & deep catheter engagement during stent withdrawal and also to facilitate stent removal directly to guide extension? Thanks.

[@NikhilJha89]

Stent brand? Usually ox equipment usage leads to these problems.