Fracture of a coronary guidewire during graft thrombectomy with the X-sizer device

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery
• Medical Device Technology

Background:

• Coronary artery bypass graft (CABG) occlusion remains a significant challenge in cardiovascular medicine.
• Thrombectomy is a crucial procedure for managing acute graft failure.
• Novel atherectomy devices aim to improve thrombectomy outcomes.

Observation:

• A rare complication occurred during thrombectomy of a massive thrombus in a recently occluded coronary bypass graft.
• A novel atherectomy catheter, the X-Sizer, was utilized in the procedure.
• A coronary guidewire fractured during the thrombectomy process.

Findings:

• The massive thrombus was successfully aspirated using the X-Sizer atherectomy catheter.
• No distal embolization of thrombus occurred.
• The fractured guidewire fragment was successfully retrieved by covering it with a coronary stent within the graft.

Implications:

• This case highlights a potential, unusual complication associated with the X-Sizer atherectomy catheter.
• Understanding the mechanism of guidewire fracture is crucial for device refinement and procedural safety.
• The successful management of the complication demonstrates the feasibility of stent-based retrieval of guidewire fragments in complex scenarios.