ArticleJACC. Case reports2026
Pedal Pull-Through Rail and Wingman-Assisted Coaxial Push for Entrapped Device Retrieval in Calcified Tibial Arteries.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
objectiveTo describe a bailout technique for retrieving an entrapped, fractured endovascular device fragment in severely calcified below-the-knee arteries when conventional snare retrieval is not feasible. KEY STEPS: 1) Immediately stop manipulation and maintain the position of the antegrade guidewire holding the fragment (the "Golden Rule"); 2) obtain retrograde access; 3) advance a snare from the retrograde sheath to capture and externalize the existing antegrade guidewire, creating a pull-through rail without wire exchange; 4) advance a Wingman catheter antegradely over the rail; and 5) apply short, coaxial pushes to dislodge the fragment and retrieve it via the retrograde sheath. POTENTIAL PITFALLS: Retrograde distal puncture and sheath insertion are difficult without a sufficient vascular diameter in either the dorsal foot artery or posterior tibial artery. Avoid loss of the guidewire during procedure and vessel injury. TAKE-HOME MESSAGE: Never surrender the workhorse wire holding the fragment; converting it into a pull-through rail enables safe coaxial dislodgement.
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