Dual Device Fragment Retrieval Using Two-Wire and Snare Technique During Percutaneous Coronary Intervention: A Case of Guide Extension Tip and Balloon Shaft Separation.

Device-related complications during percutaneous coronary intervention (PCI), such as catheter or balloon shaft separation, are uncommon but potentially life-threatening. Effective retrieval techniques are crucial to avoid surgical intervention. We report a rare case of simultaneous separation of a guide extension catheter tip and balloon shaft, successfully managed using a two-wire and snare technique. A 58-year-old man with a history of familial hypercholesterolemia underwent PCI for in-stent restenosis in the mid right coronary artery (RCA), previously treated with a sirolimus-eluting stent. After successful lesion preparation using a scoring balloon and drug-coated balloon via a 6-Fr guide extension catheter, the extension catheter became stuck in a tortuous segment. Attempted withdrawal resulted in distal tip separation. A 2.0-mm balloon was deployed inside the tip for trapping, but during retrieval the balloon shaft itself fractured. To retrieve both fragments, a second guidewire was advanced outside the separated tip with the aid of a microcatheter, followed by deployment of a Goose Neck snare. The snare successfully grasped the initial guidewire, enabling the en bloc retrieval of both the guide extension tip and the broken balloon shaft. No complications occurred, and final angiography confirmed optimal flow. This case illustrates a practical and effective two-wire plus snare technique for managing simultaneous device fragment separation during PCI. Familiarity with bailout strategies such as this may help avoid surgical retrieval or further complications in similar settings.