84-year-old gentleman with known CAD, s/p PCI (LM–oLAD, dLCx) in 2019, presented with recurrent epigastric/chest discomfort. At another hospital, planned PCI to proximal LCx was complicated by stent dislodgement. Admitted via ED for evaluation; hemodynamically stable, no overt heart-failure signs

ECG unremarkableNo Troponin leak.

Patent prior LM–LAD and distal LCx stents. Proximal LCx with diffuse 70–80% disease. Dislodged stent spanning the left main. No visible thrombus or total occlusion; TIMI 3 flow.

Initial strategy prioritized securing the migrated stent and restoring safe access to the target vessel. Wiring through the dislodged stent struts failed due to malalignment/entrapment. We therefore performed high-pressure non-compliant balloon inflations in the proximal LCx and LM–proximal LAD to crush the dislodged stent against the LM wall and re-establish a clear lumen. The proximal LCx was then treated using a reverse crush approach: LCx DES implantation, followed by sequential high-pressure NC post-dilatations, final kissing balloon inflation across the LM bifurcation, and proximal optimization of the LM segment. Final angiography confirmed TIMI 3 flow without complications, and intravascular imaging demonstrated satisfactory stent expansion and apposition.

A left main stent dislodgement was successfully managed using familiar bifurcation techniques. Balloon crush of the migrated stent, followed by reverse-crush LCx stenting, final kissing, and LM optimization, secured the hardware, restored lumen integrity, and relieved symptoms without acute complications.