Reverse longitudinal stent deformation during percutaneous intervention via the retrograde approach to a chronic total occlusion of the right coronary artery: a case report

BACKGROUND: Longitudinal stent deformation (LSD) is an uncommon but recognized mechanical complication of coronary stent implantation, usually occurring at the proximal stent edge due to compression by guide catheter or catheter extensions. Retrograde techniques for chronic total occlusion (CTO) percutaneous coronary intervention expose the distal stent edge to potential interaction with retrograde equipment under a tensioned system. CASE SUMMARY: We describe a case of distal stent edge LSD, occurring during a retrograde approach to a right coronary artery CTO via septal collateral channels. While removing the externalized wire, interaction with the retrograde microcatheter caused compression of the distal end of the newly implanted stents. DISCUSSION: This unusual complication highlights the reduced longitudinal strength of newer generation stent platforms and the risks of interaction between retrograde equipment and stents on an externalized wire.