Mr. EPSA 45 years old, heavy smoker, presented to emergency room with chest pain that had persisted for 2 hours prior to admission. First chest pain was felt 3 days ago. He was diagnosed with inferior ST Elevation Myocardial Infarction (onset >48 hour). His vital signs upon arrival at the ER were a blood pressure of 110/75 mmHg and a heart rate of 56 bpm. There were no rales and his peripheral perfusions were normal.

Using Optitorque 5Fr diagnostic catheter via 6Fr radial sheath :Left Main     : Senosis 70% at distalLAD                : Diffuse stenosis 80% at proximal to distalLCx                 : Total Occlusion at distal, flow at distal from RCA (Rentrop II)RCA                : Dominan, diffuse stenosis from proximal to distal, total occlusion at distal PL, flow to distal from LAD (Rentrop III)

JR 3.5/6Fr Guiding catheter via right radial artery was used to cannulate and wiring the RCA. Stepwise predilatation was done using semi compliant balloon 1.5, 2.0 and 3.0. However, there was difficulty to deliver stent to distal. When the stent was retracted into the guiding catheter, the stent compress against by guiding catheter tip resulting stent shorten by half and can not be retracted into the guiding catheter. The balloon stent partially inside in the guiding catheter with the compress stent still attach. Partial balloon stent which was in guiding catheter was trapped by inflating another balloon. The whole system was retracted to the right subclavia, so primary PCI can be proceed via femoral access with 8Fr sheath. A guiding catheter XB 3.5/8Fr was placed retrogradly close to deform stent. A 15 mm snare wire was inserted and the stent was successfully captured by snare wire. The stent is pulled with a snare wire into the 8Fr guiding catheter. With guided fluoroscopy, the snaring system is pulled up to the tip of the 8Fr femoral sheath. After ensuring that the stent can enter the 8Fr sheath, the snaring system is pulled out.

Longitudinal stent compression is one of the rare complications of PCI. In these primary PCI case, the stent compresses as it is retracted into the guide catheter because the guide tip reshapes from circular to various shapes when inserted too deeply to the wedge coronary artery lesion. We decided to perform femoral snaring because compressed stents can injure the brachial and radial arteries. In addition, the changing diameter of the stent due to compression will have difficult passing through the 6Fr radial sheath. Finally it can be overcome by using a loop wire technique from contralateral access and stent can be pulled out through the femoral artery.