Case Report Entanglement due to Delayed Removal of a Buddy Wire Marc Vorpahl, Melchior Seyfarth, and Klaus Tiroch Department of Cardiology, HELIOS Klinikum Wuppertal, Witten/Herdecke University, Arrenberger Strasse 20, 42117 Wuppertal, Germany Correspondence should be addressed to Marc Vorpahl; marc.vorpahl@helios-kliniken.de Received 6 October 2014; Accepted 17 December 2014; Published 29 December 2014 Academic Editor: Kenei Shimada Copyright © 2014 Marc Vorpahl et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A buddy wire is oten used to aid in the delivery of balloons and stents when negotiating tortuous or calciied vessels. We present a planned two-stent mini-crush intervention complicated by entanglement of the buddy wire with the second stent and subsequent distortion of the stent within the guiding catheter. Based on this case, we suggest removing the buddy wire immediately ater successful positioning of the irst stent, because entrapment with a second stent is possible and may lead to challenging situations in a simultaneous two-stent strategy. 1. Introduction Placement of a second coronary guide wire parallel to the working wire can be considered for challenging percuta- neous coronary interventions (PCI). Such situations include calciied lesions, tortuous vessels, and sharp bends. his “buddy wire” stabilizes the guiding backup and position by straightening of the target vessel [1]. It is recommended to remove the “buddy wire” ater stent positioning and before stent implantation to avoid entrapment of the buddy wire between the vessel and the stent. Treatment of a complex bifurcation lesion with the “mini-crush” technique using two simultaneous stents has been well described [2, 3]; however, the timing of removing a buddy wire during stent delivery is not well established. 2. Case Report An 86-year-old female presented with acute decompensated heart failure and non-ST elevation myocardial infarction. Echocardiography demonstrated severe impaired systolic let ventricular function and moderate mitral regurgitation. Car- diac catheterization revealed severe coronary artery disease with signiicant stenosis of the distal let main artery (LM) and the ostial/proximal let circumlex (LCx) (Figures 1(a) and 1(b) white arrows) and intermediate stenosis of the prox- imal let descending artery (LAD). Based on a EuroSCORE II of 36, the Heart Team decision was in favor of a percutaneous revascularization strategy. he upfront plan was to treat the let main bifurcation with a simultaneous two-stent “mini- crush” strategy. he calciied and angulated proximal LCx required a “buddy wire” (FIELDER Coronary Guide Wire, ASAHI) in addition to the working wire (ChoICE PT Extra Support Guide Wire, Boston Scientiic). Another FIELDER wire was placed into LAD. Predilation of the LAD and LCx (2.0 and 2.5 × 20 mm, NC Trek, 20atm., Abbott Vascular) occurred smoothly, and the irst stent (Xience PRO 3.0 × 28 mm, Abbott Vascular) was successfully advanced into the LCx over the ChoICE PT working wire. hen, we advanced the second stent into the LAD (Xience PRO 3.0 × 28 mm, Abbott Vascular). he advancement of the LAD stent was efortless within the guiding catheter except for the last few centimeters and within the let main, where increasing friction impeded further advancement. Surprisingly, initial attempts to pull the LCx “buddy wire” failed ater suc- cessful advancement of both stents most likely related to the twisted LCx buddy wire around the LAD wire/LAD stent (Figure 1(c)). Due to entanglement, forced pullback maneuvers of the buddy wire tore the LAD stent catheter tip of the shat, blocking the mid-part of the 7F Guiding EBU 4.0 (Medtronic) (Figure 1(e)). Fortunately, we were able to deploy let main/LCx stent without signiicant plaque shiting into the LAD, leaving an excellent single stent result (Figure 1(d)). he guide catheter was removed, revealing Hindawi Publishing Corporation Case Reports in Cardiology Volume 2014, Article ID 513737, 3 pages http://dx.doi.org/10.1155/2014/513737