Successful Application of Antegrade Dissection and Re-Entry Technique in Managing a Complex Percutaneous Coronary Intervention With Entrapped Microcatheter Tip.

This case report describes the successful management of a complex percutaneous coronary intervention (PCI) in a 78-year-old man with a history of coronary artery bypass grafts. The patient presented with refractory angina symptoms and underwent PCI to the obtuse marginal (OM) vessel. The lesion proved to be balloon and microcatheter uncrossable and subsequent entrapment of a dislodged microcatheter tip, completely occluding vessel flow. Conventional retrieval methods failed, necessitating the use of the antegrade dissection and re-entry (ADR) technique with a Stingray balloon. This approach successfully recanalized the vessel, bypassing both the original lesion and the entrapped microcatheter tip. The case highlights the importance of advanced interventional strategies, typically associated with chronic total occlusion (CTO) interventions, in resolving complex coronary complications. It emphasizes the need for interventional cardiologists to be proficient in diverse techniques to address rare but potentially serious complications during PCI.