Conservative management of broken guidewire: Case reports

Khan, Shahid; Ho, David; Dinaram, Temujin; Lazar, Jason; Marmur, Jonathan D.

doi:10.1177/2050313x14554478

Cited by 6 publications

(10 citation statements)

References 8 publications

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“…14 14,16 ) many more PCIs are performed in total and therefore thousands of more broken or entrapped devices can be expected per year. However, the reports in the literature about these complications focus on conventional and interventional therapy 5,7,9,[17][18][19][20][21][22][23] and the surgical information is limited to case reports. 5,19,[24][25][26] The largest published case series so far has reported five such cases, combining them with four cases of stent dislocation.…”

Section: Discussionmentioning

confidence: 99%

“…However, conservative treatment of such patients with systemic anticoagulation and antiplatelet agents appears more appropriate for occluded or smaller distal vessels and early surgical referral may be indicated if ischemic events are encountered. 5,17 Currently, there are no guidelines regarding the optimal management or choice of antiplatelet/ anticoagulation regimen for such patients. 17 Case reports for cases both with and without antiplatelet/anticoagulation regimen have been published.…”

Section: Discussionmentioning

confidence: 99%

“…5,17 Currently, there are no guidelines regarding the optimal management or choice of antiplatelet/ anticoagulation regimen for such patients. 17 Case reports for cases both with and without antiplatelet/anticoagulation regimen have been published. 17,18,29 The endovascular management remains another important treatment option with a number of different interventional techniques described: snare loop, double or triple wire technique, deep-guide catheter wedge, and balloon inflation techniques or stenting against the vessel wall.…”

Section: Discussionmentioning

confidence: 99%

“…17 Case reports for cases both with and without antiplatelet/anticoagulation regimen have been published. 17,18,29 The endovascular management remains another important treatment option with a number of different interventional techniques described: snare loop, double or triple wire technique, deep-guide catheter wedge, and balloon inflation techniques or stenting against the vessel wall. 5,6,12,30,31 Currently, there is no sufficient data of the use of extracorporeal mechanical circulatory support during endovascular management, but its use in cases of hemodynamic instability appears plausible in patients with contraindications for surgery.…”

Section: Discussionmentioning

confidence: 99%

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Background Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent. Methods We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014. Results From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular‐assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left‐sided minithoracotomy (n = 2). The operations were performed on‐pump in five (62.5%) and off‐pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained‐device‐related right heart failure. The other patients survived and had uneventful postoperative courses. Conclusions Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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“…7 There are only few reports of managing these retained guidewires conservatively in cardiac cases only. 8 Since there is paucity of literature on broken PTBD wire these reports which are available on cardiac guidewire guide us that these complications can be managed percutaneously as well as surgically depending on expertise available. There is only one case report mentioning radiological removal of fractured PTBD wire.…”

Section: Discussionmentioning

confidence: 99%

Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

Gupta

2019

Int Surg J

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This is a rare case of surgical removal of intrahepatic retained broken wire of percutaneous transheaptic biliary catheter, which caused cholagitis and severe pain in a 59-year-old female who had undergone percutaneous transhepatic biliary dilatation of stricture hepaticojejunostomy in past. This is rare case ever reported of surgical removal of a broken PTBD wire retained inside left biliary system, post percutaneous transhepatic biliary dilatation of biliary stricture. Patient also underwent redo-hepaticojejunostomy for treatment of stricture hepaticojejunostomy in same sitting. This guidewire was put by interventional radiologist for dilatation of hepaticojejunostomy stricture. Patient had developed stricture in hepaticojejunotostomy which was done in year 2007 along with choledochal cyst excision by some other Gastrosurgeon. But one reoperation as well as one interventional approach had failed to retrieve the wire retained in biliary system. After that we successfully operated this challenging case and cured her of stricture hepaticojejunostomy, cholagitis and removed the foreign body in one surgery. Postoperatively we followed her up of 2 yrs. Patient is afebrile ,free of jaundice and has normal LFT on 2 yrs of follow up.Broken guidewire during percutaneous intervention in obstructed biliary system is an emergency as it acts as foreign body, removal with reansatomosis gives a fair chance of cholangitis free survival to patient.

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Retrieving entrapped guidewire using rotablation technique: case series and literature review

Chen

Wang

2022

European Heart Journal - Case Reports

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Background The present article summarizes three cases of retrieving entrapped guidewire using rotablation technique. Case summary All three cases pertained to guidewire being fractured and entrapped during percutaneous coronary interventions (PCI) for right coronary artery (RCA) chronic total occlusion (CTO) in a local hospital. In case 1, two fractured filaments connecting to the entrapped guidewire could be clearly seen. One filament was in the right brachial artery and the other one was in the ascending aorta. In case 2, the operator applied buddy wire technique during PCI but forgot to withdraw the second wire before stenting. As a result, the second SION wire was entrapped by the stent, and was untangled and fractured when being retrieved. In case 3, a SION guidewire was entrapped during PCI for RCA. The initial attempt to retrieve the guidewire ended in failure. Although the entrapped guidewire was still intact, it was difficult to advance the floppy rotawire into the RCA as it was still totally occluded. In those scenarios, complete retrieval of the entrapped guidewire using catheter-based technique was hardly possible. Rotablation was used to cut the entrapped guidewire, retrieve the broken end and leave the remnants in coronary artery jailed by the stent. Clinical and angiographic follow-up observation demonstrated that the patients were free of target vessel failure. Discussion Entrapment of guidewire is a rare complication of PCI. The management of entrapped guidewire is usually challenging. Rotablation technique is a useful and efficient strategy when conventional methods failed to retrieve the entrapped guidewire.

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Conservative management of broken guidewire: Case reports

Cited by 6 publications

References 8 publications

Lost in circulation

Lost in circulation

Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

Retrieving entrapped guidewire using rotablation technique: case series and literature review

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