Background: Bifurcation Percutaneous Coronary Intervention (PCI) is one of the most challenging procedures in interventional cardiology. Although established techniques like the Double Kissing (DK)-crush strategy and provisional stenting have improved results, new failure modes keep appearing.
Case Presentation: We present a 59-year-old man with type 2 diabetes who had an infero-posterior ST-Elevation Myocardial Infarction (STEMI). Coronary angiography showed a total blockage of the Left Circumflex Artery (LCX) beyond the first obtuse marginal branch. The initial stenting was complicated by no-reflow and dissection at the proximal edge, which required more stents. During attempts to rewire, the guidewire got trapped, causing a focal stent collapse. Intravascular Ultrasound (IVUS) showed an unusual spiraling inward folding of the stent struts, which we call the “Swiss Roll Effect.” This rare mechanical problem was handled with special guidewires, microcatheters, and sequential balloon dilations, followed by successful stenting from the left main to LCX.
Discussion: The Swiss Roll Effect shows a unique geometric failure pattern that is different from the previously described longitudinal or malapposition-related deformations. This case emphasizes how intravascular imaging helps to identify and fix unexpected mechanical issues during bifurcation PCI.
Conclusion: Awareness of the Swiss Roll Effect may aid operators in recognizing early signs of resistance, avoiding excessive manipulation, and adopting imaging-guided bailout strategies.

Keywords:Bifurcation stenting; Stent deformation; Intravascular ultrasound; Percutaneous coronary intervention; Stent collapse

Abbreviation List: DK-crush: Double Kissing crush technique; IVUS: Intravascular Ultrasound; LCX: Left Circumflex Artery; LM: Left Main (Coronary Artery); PCI: Percutaneous Coronary Intervention; STEMI: ST-Elevation Myocardial Infarction