A 53-year-old man was planned for staged PCI to the left circumflex artery (LCX). He had history of primary PCI at the proximal left anterior descending (LAD) 6 months earlier. Following coronary angiogram, it was decided to perform an initial optical coherence tomography (OCT) evaluation. However, during delivery to the LAD, the OCT catheter was railed-off from the guidewire and knocked to the ostial LCX. After guide-catheter repositioning and double-kissing culotte stenting at the left main bifurcation, the patient was finally stabilized. The purpose of these images is to make the readers aware of the genuine and serious risk of a "railed off" OCT catheter, especially while delivering the catheter at a bifurcation with an eccentric lesion. Meticulous OCT catheter delivery and improvement of the OCT catheter configuration may be considered to avoid this complication.
Keywords: OCT catheter; cardiac imaging; complications; ostial circumflex.