Cutting balloon angioplasty (CBA) is one of the adept ways of treating “in-stent restenosis.” Various complications related to cutting balloon angioplasty have been reported including arterial rupture, delayed perforation and fracture of microsurgical blades. Here we report a very unusual and inadvertent extraction of a stent previously deployed in the ramus intermedius coronary branch by a cutting balloon catheter. This required repeat stenting of the same site for an underlying dissection. Even though stent extraction is a rare complication it can be serious due to dissection, perforation, and closure of the artery. Physicians performing coronary artery interventions would need to be aware of this rare and serious complication especially if any difficulty is encountered while withdrawing the cutting balloon. Therefore, after removal, cutting balloon should be examined thoroughly for possible stent dislodgment or extraction when used for “in-stent restenosis.” 1. Introduction In-stent restenosis is one of the important causes of failure of previously successful percutaneous intervention (PCI). Restenosis occurs secondary to neointimal tissue proliferation which is mediated by inflammation following arterial injury [1, 2]. Drug eluting stents (DES) have greatly reduced rates of restenosis compared to that of bare metal stents [3–5]. However, there are no clear guidelines for appropriate therapy of DES restenosis, probably due to low incidence of restenosis and its varied etiology [6]. Cutting balloon angioplasty (CBA) is one of the safest, cost effective, and adept ways of treating in-stent stenosis [7–9]. Cutting balloon has 3-4 microsurgical blades attached to its surface longitudinally. Inflation of the balloon will result in cutting of atherosclerotic plaque. This creates controlled injury and potentially reduces inflammation. Various complications related to CBA have been reported including arterial rupture, perforation, and fracture of microsurgical blades [10–12]. In this case report we present an unforeseen complication of CBA in which a previously deployed stent is inadvertently extracted along with the cutting balloon. 2. Case Presentation A 71-year-old Caucasian male patient with past medical history of coronary artery disease, hypertension, congestive heart failure, and stroke presented with the chief complaint of left arm pain and dyspnea. He had similar symptoms five months prior to the current admission at which time he underwent PCI with an Ion (Boston Scientific) DES stent (2.5 × 24？mm) placement to a moderate caliber ramus intermedius
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