Retrieval of trapped and broken guide wire with immediate rescue off-pump coronary bypass surgery

Abstract

The entrapment, fracture and dislodgement of diagnostic or therapeutic devices within the coronary circulation during a procedure are a rare complication occurring in 0.2-0.8% of cases. Despite technological improvements, this complication is still occurring because coronary angioplasty is often undertaken for complex anatomical situations. The complication of device fracture during the intervention procedure occurs due to entrapment, overcoiling and excessive traction of the guide wire. There has been no agreement as to whether and by which technique the immediate removal of the broken fragment of guide wire should be done. Here, we report a case of anterolateral myocardial infarction who underwent primary percutaneous coronary intervention. During the procedure, the guide wire was entrapped within the left anterior descending coronary artery. Despite many attempts, the wire could not be removed and even became fractured at the femoral insertion site; thus, urgent surgical removal of the wire with vessel grafting was done with a successful outcome. This gives a clear message about the importance of the ready availability of surgical backup and, particularly, the necessity for complex percutaneous interventions.

Lost in circulation

“…Our patients were referred from six different cardiology departments and were all performed by different interventional cardiologists, therefore likely excluding a specific human influence as a possible cause. Other authors have also noted that despite technical improvements in the quality of the wires, the incidence of this complication has not decreased over the last decades and may become even higher 25. Our data show that having an individualized approach is important when surgically treating patients with wire, balloon, or device entrapment.…”

“…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. 27 Thus, it appears as if there is a significant publication bias for these cases and our ability to assess true outcomes of surgery for these complications is currently very limited.…”

Surgical rescue of guidewire in-stent entrapment during coronary angioplasty

“…3 The first episodes of broken guidewires were described in 1980. 4 Despite procedural refinement and the introduction of high-quality devices, the frequency of these complications has risen because of the increased number of difficult cases. Several conditions may increase the risk of wire entrapment or fracture, including acute angulation of the wire in a side-branch, a calcified vessel, and implantation in a curved section of the vessel.…”

Successful device retrieval using simple balloon method during cardiac procedures

“…However, we believe that cardiothoracic surgery should be considered as the last resort and attempts should be made for percutaneous retrieval [3, 5]. Since there is no single technique, which will succeed in all situations, interventionists should be familiar with different percutaneous methods for the retrieval [6, 7]. The commonly used percutaneous retrieval techniques include the use of baskets, snare loop, goose-neck snare, indigenously made loop snare, paired guidewires knotted together, double or triple wire technique, tornus catheter, and biopsy forceps [5, 6].…”