Intentional retrieval of a protruding ostial left main drug-eluting stent using a snare: a bail-out case report

Abstract

Background: Percutaneous coronary intervention (PCI) of the ostial left main coronary artery (LMCA) is technically demanding and carries specific risks related to inaccurate stent positioning. Excessive stent protrusion into the aorta is a rare but potentially catastrophic complication. Case summary: We report the case of a 60-year-old man with diabetes mellitus admitted for an acute coronary syndrome equivalent to ST-segment elevation myocardial infarction, related to a critical ostial LMCA stenosis. During emergent PCI, patient agitation led to excessive proximal protrusion (>8 mm) of a drug-eluting stent into the ascending aorta. Balloon optimization failed and resulted in stent deformation. Given the high risk of thrombosis, embolization, and aortic valve interference, intentional stent retrieval using a snare device was successfully performed, followed by optimal re-stenting of the LMCA ostium. The patient had an uneventful recovery. Discussion: Intentional extraction of a protruding coronary stent is exceptionally rare, particularly in the ostial LMCA. This case highlights the feasibility and safety of snare retrieval as a bail-out strategy when performed early, before endothelialization, and in carefully selected patients.