Case 93: Manual of PCI - Hairpin Trap

A patient was referred for PCI of a high-grade lesion of the saphenous vein graft to the right coronary artery. A 3.5x18 mm DES was placed in the SVG over a Filterwire. Due to poor antegrade flow the filter was removed. Attempts to advance a non-compliant balloon for postdilation resulted in distal migration of the stent. IVUS showed that the new guidewire was partially and partially out of the stent that was markedly undersized compared with the SVG. The small balloon technique failed to retrieve the stent. The “hairpin-trap” technique was used for retrieval, in which a guidewire is bend 180 degrees 3 cm from the tip and inserted in the Tuohy with the knuckled end first. The wire is then withdrawn, “hooking” the stent and the wire tip inserted into the guide catheter, where it is trapped with a balloon, followed by removal of the entire assembly. The stent was successfully retrieved from the SVG. but could not enter the femoral sheath. It was snared from the contralateral groin and embolized in the popliteal artery from which it was eventually successfully snared. PCI was subsequently completed without complications with an excellent final result. It later became apparent that the initially implanted stent was not 3.5 mm in diameter, but was actually 2.5 mm, which led to the stent deformation and loss. Checking the label of each equipment before inserting into the body is critical.