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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

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

Manrico Balbi1, Gian Paolo Bezante, Claudio Brunelli

  • 1Department of Internal Medicine, Cardiology Unit, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy.

Interactive Cardiovascular and Thoracic Surgery
|March 31, 2010
PubMed

Insights

A fractured guidewire during complex coronary bifurcation stenting required rescue heart surgery. The patient recovered well, highlighting the importance of surgical preparedness for percutaneous coronary intervention complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease management often involves percutaneous coronary intervention (PCI) for complex bifurcations.
  • The 'jailed' wire technique is used to protect side branches during main vessel stenting.
  • Procedural complications can arise, necessitating alternative treatment strategies.

Observation:

  • A 46-year-old woman presented with myocardial ischemia and critical stenosis of the left anterior descending artery bifurcation.
  • During PCI, a guidewire fractured, with fragments lodged in the side branch and proximal coronary arteries.
  • Conservative management of the fractured wire was chosen, followed by surgical intervention.

Findings:

  • Successful surgical retrieval of the fractured guidewire and bypass grafting of the side branch were performed.
  • Post-operative angiography at nine months showed no in-stent restenosis.
  • The patient remained event-free at 18 months of clinical follow-up.

Implications:

  • Complex coronary bifurcation PCI carries inherent risks, including device-related complications.
  • Rescue surgical revascularization is a viable option for managing PCI-induced complications.
  • Multidisciplinary preparedness is crucial for optimizing outcomes in high-risk interventional procedures.

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