Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade

Woodfield, Scott L.; Lopez, Alejandro; Heuser, Richard R.

doi:10.1002/(sici)1097-0304(199806)44:2<220::aid-ccd20>3.0.co;2-p

Cited by 29 publications

(7 citation statements)

References 19 publications

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“…CP in these situations usually amounts to severe morbidity or death. Though incidences of CP following RA had been reported before [ 5 , 6 , 9 ], the exact mechanisms for perforation were less well investigated and characterized [ 6 , 10 – 12 ], despite several predictors are well known [ 7 ]. This study was set out to explore the incidence of CPs and define mechanisms of CPs following RA in a single tertiary care center.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Wang

Chen

et al. 2020

Journal of Interventional Cardiology

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Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall.

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Section: Introductionmentioning

confidence: 99%

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Wang

Chen

et al. 2020

Journal of Interventional Cardiology

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“…Entrapments on hardware materials of angioplasty have been reported for guidewires, balloons, Rotablator systems, stents, and angiographic catheters usages 7)8). The complications of remnant guidewires could be life-threatening because it could lead to coronary thrombosis, perforation and embolization 3)4). Bifurcation lesions, tortuous and calcified lesion, use of firm tipped guidewire are important risk factors for guidewire entrapments and fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Guidewire fractures are very rare with an incidence of approximately from 0.1% to 0.2% of cases 1)2). Although remnant guidewires can lead to life-threatening complications,3)4) and recently, percutaneous retrieval techniques are considered good therapeutic options, there have been several reports on the remnants being left in coronary artery and aorta without any serious adverse outcomes 5)6)…”

Section: Introductionmentioning

confidence: 99%

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

Kim

Park

et al. 2013

Korean Circ J

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During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.

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“…Cases of burr entrapment in the highly calcified lesions and inability to withdraw the burr after passing narrow lesions are well known and have been reported [4–10]. There is also a possibility of guidewire damage done by a burr that remained too long time in the same place and when the treated vessel is tortuous [11, 12]. There are only a few descriptions of complications similar to the one described above (spontaneous burr detachment) available in the literature, mainly in U.S. Federal Food and Drug Administration (FDA) reports [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous retrieval of a detached rotational atherectomy burr

Kosowski

Zimoch

Kübler³

et al. 2013

pwki

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Rotablation (rotational atherectomy) is an acknowledged method of percutaneous treatment of highly calcified coronary artery lesions that cannot be treated with traditional angioplasty. The complexity of the technique and usage of very specific equipment can contribute to the development of uncommon complications. We present a case of percutaneous retrieval of a damaged rotational atherectomy burr in a 74-year-old male patient.

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Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade

Cited by 29 publications

References 19 publications

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

Percutaneous retrieval of a detached rotational atherectomy burr

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