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Retained percutaneous transluminal coronary angioplasty equipment components and their management
G O Hartzler1, B D Rutherford, D R McConahay
1Mid America Heart Institute, Kansas City, Missouri.
Insights
Complications during percutaneous transluminal coronary angioplasty (PTCA) can lead to retained guidewire fragments. Many of these retained fragments can be successfully extracted, and some may cause no long-term issues.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure.
- Complications involving retained equipment components can occur during PTCA.
Purpose of the Study:
- To report on the incidence and management of retained PTCA equipment components.
- To evaluate the outcomes of extraction procedures for retained intracoronary fragments.
Main Methods:
- Review of 5,400 consecutive PTCA procedures to identify retained components.
- Analysis of extraction procedures using various tools, including bioptomes.
- Late follow-up assessment of patients with retained fragments.
Main Results:
- 12 patients experienced retained PTCA components, most commonly guidewire fragments.
- Successful extraction was achieved in 4 out of 5 procedures.
- Long-term retained guidewire segments within the coronary circulation showed no attributable sequelae in 5 patients.
Conclusions:
- Fractured intracoronary wires extending into the aorta are often extractable.
- Retained guidewire segments within the coronary circulation may be benign, especially when occluded.
- Bioptomes are effective for removing fragments from the aorta and assisting with catheter retrieval.
Abstract:
Of 5,400 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures, 12 patients had complications resulting in retention of 1 or more PTCA equipment components. Eight patients had guidewire fragments retained within the coronary circulation, including one with a second wire segment within the abdominal aorta. A gold band catheter marker was retained within a coronary artery in 1 patient. Four of 5 extraction procedures in these patients were successful, including retrieval of a wire segment totally contained within the distal circumflex coronary artery. Bioptomes were used to retrieve guidewire segments from the abdominal aorta in 4 patients and a knotted guiding catheter from another. At late follow-up, 5 patients with wire segment retained for an extended time within the coronary circulation had no sequelae attributable to the PTCA component debris. We conclude that many fractured intracoronary wires with proximal portion extending into the ascending aorta can be extracted. Guidewire segments retained for a long time totally within the coronary circulation may be benign, particularly when entrapped within total coronary occlusions. Bioptomes can be used effectively to remove wire segments within the abdominal aorta and to assist in the removal of kinked guide catheters.