Guide wire fracture during percutaneous transluminal coronary angioplasty: possible causes and management

Abstract

A 46-year-old woman underwent diagnostic coronary angiography in our institution due to a myocardial ischemia following a dobutamine echo-stress test. The patient showed critical stenosis of the left anterior descending (LAD) artery involving the ostium of a large diagonal branch. The planned treatment of coronary bifurcation by percutaneous coronary intervention (PCI) was direct stenting of the main branch with 'jailed' wire technique to protect the side branch, provisional T stenting of the side branch, and final kissing balloon inflation. After successful stent implantation in the LAD, the 'jailed' wire fractured during withdrawal: the distal part of the fragment was trapped in the side branch, and the proximal one was knotted in the LAD, left main coronary and the aortic bulb. We decided not to retrieve the fragment by snare, and we planned heart surgery to safely retrieve the fragment and bypass the side branch not treated by percutaneous coronary interventions. Angiographic control nine months after surgery showed non in-stent restenosis; patient is alive and event-free at 18 months' clinical follow-up. In conclusion, percutaneous management of particularly complex bifurcational lesions may be associated with procedural risks; accordingly, it is important to consider and be ready for a rescue surgical revascularization.

Jailing polymer jacketed guide-wires during bifurcation coronary interventions is associated with procedural myocardial infarction

“…However the interventional community has been wary of these as the initial reports of wire rupture were consistently with hydrophilic PGW[8]. Since then multiple reports of non hydrophilic wires being entrapped have been published as well[16-19]. With the lesser degree of lubricity of a non PGW, greater force may be required to extract the wire and hence risk deep intubation of the guide catheter and injury to the vessel as well.…”

Is Surgical Approachment to a Retained and Fractured Guide Wire Inside Coronary Artery Necessary Followings Coronary Angiography?

“…Kırılan parçaya müdahale edilmeyeceği durumlarda hastaya uzun dönem antikoagülan ve antitrombotik tedavi başlan-ması olası tromboz risklerini de en aza indirecektir (5) .…”

Side-branch wire entrapment: Early recognition and management

“…After 2007, most reported cases of entrapped wires involved treatment of bifurcation lesions. Percutaneous removal [34567] and surgical removal [89101112] of the trapped wires, and even leaving the wires in situ [613], result in no major complications in most cases. However, a few life-threatening complications have been reported, such as death from stent thrombosis [8] and unintended stent removal [3].…”