Guide Extension and Balloon-Assisted Retrieval of an Entrapped Embolic Protection Device Within a Coronary Stent: A Case Report and In Vitro Analysis.

The entrapment of an embolic protection device (EPD) within a coronary stent is a rare but serious complication for which established bailout strategies are lacking. Herein, we report a case of stent deformation caused by EPD entrapment at the distal stent edge. We conducted an in vitro bench study to elucidate the mechanism of entrapment and present the novel, mechanically optimized bailout strategy we used to treat our patient. A 65-year-old man underwent percutaneous coronary intervention for attenuated plaque in the right coronary artery. EPD entrapment and subsequent stent deformation occurred during the procedure. Our in vitro analysis demonstrated that applying traction to an entrapped EPD consistently causes coronary stent deformation before the nitinol filter is fractured, confirming the danger of performing routine forceful retrieval. We utilized a bailout technique involving a guide extension catheter that was internally reinforced with a balloon catheter. The balloon acted as a rigid internal scaffold, providing robust axial support and preventing the system from buckling. We successfully applied this mechanically optimized approach in our patient, facilitating safe EPD retrieval without further dislodging the stent. The deformed segment of the stent was successfully repaired, and the patient remained event-free over 2.5 years of follow-up. Forceful traction of an entrapped EPD poses a high risk of severe stent deformation. Using a bailout strategy in which a balloon-reinforced guide extension catheter is utilized maximizes axial support, enabling safe device retrieval and effective management of this complex complication.