A 70 years old lady with diabetes mellitus, hypertension, dyslipidaemia, has been having effort angina of Canadian Cardiovascular Society (CCS) class II for a year. The physical examination showed no relevant clinical findings. The ECG was showed sinus rhythm with no ischemic changes.  

A transthoracic echocardiography showed normal left ventricular ejection fraction with no regional wall motion abnormalities. She underwent treadmill exercise stress test, which was positive. She had history of percutaneous coronary intervention done to the right coronary artery three months prior and the left anterior descending artery was planned for a staged procedure. 

Coronary angiography revealed a dual vessel disease. The left main stem had moderate tubular disease. The left anterior descending artery (LAD) was calcified, proximal and mid 90% disease, involving the main diagonal with Medina classification 1,1,1. The left circumflex (LCx) was non dominant, proximal 90% disease. The previously treated RCA segment was patent with mild residual disease. 

Staged PCI of the LAD was done via a trans radial approach using a 7 Fr radial sheath and a 7 Fr EBU 3.5 guiding catheter. A workhorse guidewire and a Finecross microcatheter was passed into the distal LAD. The guidewire was exchanged to ROTAWIRE™ Drive and Rotablation was done with 1.5 burr with 160k RPM for 5 runs. In view of Medina 1,1,1 bifurcation lesion, we decided to protect the main diagonal branch with BMW guidewire. Intravascular Ultrasound (IVUS) showed heavy calcification with calcium nodule. The proximal to distal LAD lesion was further predilated with scoring and non-compliant balloons with good balloon expansion. The distal LAD lesion is treated with drug coated balloon2.25 x 40 mm. The proximal to mid LAD lesion was stented with 2.75 x 33 mm drug eluting stent, deployed at 14 atm. After stenting however, the main diagonal branch wire was trapped. A firm traction of the diagonal wire was unsuccessful in its removal. An attempt to advance the microcatheter outside the stent strut to release the trapped segment failed.  The microcatheter was removed and a semi-compliant (SC) 0.85 x 10 mm balloon was advanced abluminally in leopard crawl technique. However, it failed to advance further. An SC balloon 2.5x 15 mm was inflated at the mid LAD as an anchor for extra support and another shorter 0.85 mm SC balloon of 5mm was passed abluminal to the stent with leopard crawl method and the diagonal wire was successfully released from the trapped segment and retrieved.

Entrapped guidewire is a common complication of percutaneous coronary intervention, especially in high risk lesions such as calcification.  Our side branch guidewire was entrapped between main vessel stent strut and calcified plaque, possibly due to the deployment of the stent at higher pressure. We successfully retrieved the entrapped guidewire using leopard crawl technique using a small and short balloon under the stent strut with an anchoring balloon at distal main vessel as extra support.