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A case of guide wire fracture with remnant filaments in the left anterior descending coronary artery and aorta.

Hong YM, Lee SR - Korean Circ J (2010)

Bottom Line: Guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but when they do occur they may lead to life-threatening complications, such as embolization, thrombus formation and perforation.In cases when percutaneous retrieval has failed, surgical extraction of the remnant fragments is recommended.We present a case of remnant guide wire filaments that remained in place without complications, over a one-year clinical follow up period.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but when they do occur they may lead to life-threatening complications, such as embolization, thrombus formation and perforation. In cases when percutaneous retrieval has failed, surgical extraction of the remnant fragments is recommended. We present a case of remnant guide wire filaments that remained in place without complications, over a one-year clinical follow up period.

No MeSH data available.


Related in: MedlinePlus

Remnant guide wire filaments were located from the coronary artery to the aortic arch. LAD: left anterior descending coronary artery, LCX: left circumflex coronary artery, LM: left main coronary artery, RCA: right coronary artery.
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Figure 4: Remnant guide wire filaments were located from the coronary artery to the aortic arch. LAD: left anterior descending coronary artery, LCX: left circumflex coronary artery, LM: left main coronary artery, RCA: right coronary artery.

Mentions: A 78-year-old woman presented with NSTEMI. Echocardiography showed decreased left ventricular systolic function (ejection fraction 45%). A diagnostic coronary angiogram showed diffuse significant stenosis from the proximal to middle LAD and first diagonal branch (D1) (Fig. 1). There was total thrombotic obstruction at the middle right coronary artery. We initially treated the patient with a single paclitaxel-eluting stent (2.75×32 mm Taxus®, Boston Scientific, Natick, MA, USA). Four days later, two coronary angioplasty 0.014 guide wires were inserted {one hi-torque Balance Middleweight (BMW) universal coronary guide wire (Abott Vascular, Santa Clara, CA, USA) into the LAD, and one high-torque Whisper coronary guide wire (Abott Vascular) into the D1}. An intravascular ultrasound after predilatation with a 2.5×20 mm Voyager® balloon (Abott Vascular) revealed a large plaque burden at both the LAD and the D1. We deployed two overlapped sirolimus-eluting stents at the proximal and middle LAD: a 2.75×33 mm Cypher® at the middle LAD and a 2.75×18 mm Cypher® at the proximal LAD (Cordis Corporation, Miami Lakes, FL, USA). When we exchanged the guide wires to perform kissing balloon angioplasty, a fracture occurred at the distal tip of the BMW guide wire (Fig. 1). Another guide wire was inserted to perform a beaded wire rotation, and distal balloon inflation retrieval was attempted, in order to remove the fractured guide wires. This attempt, however, was ineffective. Finally, we used a goose neck loop-snare (Microvena Corporation, St. Paul, MN, USA) to remove the fractured guide wires. Multiple forward and backward movements of the snare, combined with distal balloon inflation retrieval, successfully removed most of the fractured guide wires (Fig. 2) but we later observed retained filaments during echocardiography (Figs. 3 and 4). The patient declined surgical intervention for removal of these stray filaments and was discharged from our hospital, with triple anti-platelet medication and no complications. The patient did not experience any thrombotic or embolic events and did not suffer from any subjective symptoms over the one year of clinical follow up.


A case of guide wire fracture with remnant filaments in the left anterior descending coronary artery and aorta.

Hong YM, Lee SR - Korean Circ J (2010)

Remnant guide wire filaments were located from the coronary artery to the aortic arch. LAD: left anterior descending coronary artery, LCX: left circumflex coronary artery, LM: left main coronary artery, RCA: right coronary artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957644&req=5

Figure 4: Remnant guide wire filaments were located from the coronary artery to the aortic arch. LAD: left anterior descending coronary artery, LCX: left circumflex coronary artery, LM: left main coronary artery, RCA: right coronary artery.
Mentions: A 78-year-old woman presented with NSTEMI. Echocardiography showed decreased left ventricular systolic function (ejection fraction 45%). A diagnostic coronary angiogram showed diffuse significant stenosis from the proximal to middle LAD and first diagonal branch (D1) (Fig. 1). There was total thrombotic obstruction at the middle right coronary artery. We initially treated the patient with a single paclitaxel-eluting stent (2.75×32 mm Taxus®, Boston Scientific, Natick, MA, USA). Four days later, two coronary angioplasty 0.014 guide wires were inserted {one hi-torque Balance Middleweight (BMW) universal coronary guide wire (Abott Vascular, Santa Clara, CA, USA) into the LAD, and one high-torque Whisper coronary guide wire (Abott Vascular) into the D1}. An intravascular ultrasound after predilatation with a 2.5×20 mm Voyager® balloon (Abott Vascular) revealed a large plaque burden at both the LAD and the D1. We deployed two overlapped sirolimus-eluting stents at the proximal and middle LAD: a 2.75×33 mm Cypher® at the middle LAD and a 2.75×18 mm Cypher® at the proximal LAD (Cordis Corporation, Miami Lakes, FL, USA). When we exchanged the guide wires to perform kissing balloon angioplasty, a fracture occurred at the distal tip of the BMW guide wire (Fig. 1). Another guide wire was inserted to perform a beaded wire rotation, and distal balloon inflation retrieval was attempted, in order to remove the fractured guide wires. This attempt, however, was ineffective. Finally, we used a goose neck loop-snare (Microvena Corporation, St. Paul, MN, USA) to remove the fractured guide wires. Multiple forward and backward movements of the snare, combined with distal balloon inflation retrieval, successfully removed most of the fractured guide wires (Fig. 2) but we later observed retained filaments during echocardiography (Figs. 3 and 4). The patient declined surgical intervention for removal of these stray filaments and was discharged from our hospital, with triple anti-platelet medication and no complications. The patient did not experience any thrombotic or embolic events and did not suffer from any subjective symptoms over the one year of clinical follow up.

Bottom Line: Guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but when they do occur they may lead to life-threatening complications, such as embolization, thrombus formation and perforation.In cases when percutaneous retrieval has failed, surgical extraction of the remnant fragments is recommended.We present a case of remnant guide wire filaments that remained in place without complications, over a one-year clinical follow up period.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but when they do occur they may lead to life-threatening complications, such as embolization, thrombus formation and perforation. In cases when percutaneous retrieval has failed, surgical extraction of the remnant fragments is recommended. We present a case of remnant guide wire filaments that remained in place without complications, over a one-year clinical follow up period.

No MeSH data available.


Related in: MedlinePlus