A 72-year-old man with a history of hypertension was admitted to the cardiology department with a diagnosis of non–ST-segment elevation myocardial infarction (NSTEMI). Emergency angiography demonstrated multivessel coronary disease with totally occluded circumflex artery (LCx) (Figure 1A). Consequently, the LCx was revascularized with implantation of 2 stents: 2.25 mm (Orsiro Mission, Biotronik, Lake Oswego, Oregon, United States) and 2.5 mm (Biotronik AG, Bülach, Switzerland) jailing the large marginal branch (MG). During pulling out from the MG, the Sion Blue J guidewire (Asahi Intecc, Nagoya, Japan) was entrapped under the stent in the LCx. Forceful attempts to retrieve it caused stretching of the radiopaque distal tip and defragmentation of the guidewire shaft inside the guide catheter (Figure 1B). Finally, the damaged guidewire was blocked by inflated balloon catheter (Solarice, Medtronic, Minneapolis, Minnesota, United States) inside the end part of the guide catheter and retracted “en block” with the whole system (Figure 1C). The final result of the procedure was satisfactory and the patient was referred for the next stages of coronary revascularization.
A rupture of the guidewire is an uncommon but very serious complication with an estimated incidence of 0.1% to 0.2%.1,2 Leaving the guidewire within the coronary artery can lead to perforation, thrombosis, embolic phenomena, and the vessel occlusion. Management depends on the clinical situation and position of the guidewire inside the vessel, and extends from conservative to surgical treatment.3 Percutaneous retrieval techniques include application of a snare-loop, double or triple wire technique, deep wedging of the guiding catheter and traction of the system, the balloon inflation technique, microcatheter, for example, tornus catheter, extraction with bioptome, or stenting against the vessel wall.4 In the presented case, a simple technique with the balloon catheter allowed for safe and effective guidewire retrieval from the coronary artery.
Artur Pawlik, MD, Department of Cardiology and Cardiovascular Interventions, University Hospital, ul. Jakubowskiego 2, 30-688 Kraków, Poland, phone: +48 12 400 22 50, email: arturo.pawlik@gmail.com
February 2, 2023.
February 16, 2023.
February 28, 2023.
None.
None.
None declared.
Zdzierak B, Pawlik A, Bartuś S, Januszek R. Successful percutaneous retrieval of a guidewire remnant entrapped under a coronary stent. Pol Arch Intern Med. 2023; 133: 16447. doi:10.20452/pamw.16447
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