Novel Use of Intravascular Lithotripsy for the Mobilization of an Entrapped Coronary Guidewire in a Heavily Calcified LAD/DB Bifurcation Lesion-A Case Report.

A 64‑year‑old man with a Non-ST‑elevation myocardial infarction (NSTEMI) underwent coronary angiography, which revealed single‑vessel disease with a high‑grade proximal and a severely calcified mid‑LAD lesion just proximal to a diagonal branch (DB). Both the LAD and the DB were wired. During balloon angioplasty and stenting of the LAD, the jailed diagonal‑branch wire became entrapped behind the stent and could not be retrieved. Multiple maneuvers, including microcatheter‑assisted retrieval attempts, failed to mobilize the wire. As a bailout strategy, an intravascular lithotripsy (IVL) balloon was advanced over the LAD wire, and IVL was performed within the stented segment to fracture the underlying calcification. After IVL application, the entrapped wire was easily withdrawn, and the procedure was completed without further complications. This case illustrates the potential role of IVL as an effective bailout strategy for guidewire entrapment during complex coronary interventions.