Wondering PTCA Wire: Retrieval by Tangling Technique
Santosh Kumar Sinha1, Chandra Mohan Verma1, Vinay Krishna1
1Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh 208002, India.
Insights
A fractured guidewire during percutaneous coronary intervention (PCI) was successfully retrieved using a novel tangling technique with multiple guidewires. This innovative approach offers a potential solution for complex interventional cardiology complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common treatment for acute myocardial infarction.
- Complex coronary anatomy and procedural complications can challenge PCI success.
- Guidewire fracture is a rare but serious complication during PCI.
Abstract:
A 38-year-old man underwent coronary angiography in our institution due to acute myocardial infarction as part of pharmaco-invasive strategy following thrombolysis. The patient showed total occlusion of mid left anterior descending (LAD) artery which was tortuous and calcified. The planned treatment was percutaneous coronary intervention (PCI) of culprit artery with wire being "jailed" in obtuse marginal branch of left circumflex artery (LCX) as left main was short and because of lesion characteristics. After successful stent implantation in the LAD, the "jailed" wire fractured as guiding catheter got deeply intubated as stent was being deployed in LAD. Initially, two balance middle weight (BMW) wires were used to retrieve but failed. Wire was wondering as it moved to proximal LCX, left main, partly into aortic sinus, sometimes proximal LAD and finally to LCX again during retrieval. Then it was decided to use tangling technique with the help of three BMW wires acting as rescue wires. The proximal ends of all three wires were inserted together in a torque device which were firmly screwed and rotated 40 - 50 times in circular pattern. During this rotational motion, the broken segment was tangled within these rescue wires and all four wires were removed together.
