Dual-Access Secure-and-Pull Technique of an Entrapped Left Main Stent With Late Mechanical Failure

BACKGROUND: Stent entrapment within a previously implanted left main (LM) scaffold is a rare but high-risk complication. Although snare retrieval is an effective bailout strategy, traction may induce occult structural injury. CASE SUMMARY: A 63-year-old man underwent emergent LM-to-left anterior descending (LAD) bifurcation stenting after resuscitated cardiac arrest (day 0). At month 8, angiography for lateral ischemia showed mid-distal left circumflex (LCx) disease and moderate LAD ostial in-stent restenosis. An initial kissing-balloon inflation (LAD: 3.5 mm, LCx: 3.0 mm) was performed. During LCx stent delivery, the device became entrapped within proximal aorto-ostial LM struts. A dual-access ping-pong "secure-and-pull" snare technique enabled controlled retrieval while preserving distal guidewire access. Immediate kissing-balloon optimization followed. At month 21, limited inferior ischemia prompted reassessment. Despite no critical LM stenosis, StentBoost revealed complete scaffold disorganization, requiring LM restenting. Systematic intravascular ultrasound at month 31 confirmed durable expansion and apposition. CONCLUSIONS: Dual-access controlled snare retrieval provides a structured bailout for aorto-ostial LM entrapment. However, angiographic normalization may underestimate traction-induced injury, and systematic intravascular imaging is mandatory after complex LM retrieval.