A case of fractured guide wire perforating the coronary artery and ascending aorta during percutaneous coronary
Shigenori Ito1, Takayuki Yoshida1, Hisao Suda2
1Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan.
Insights
A rare hydrophilic guide wire fracture during percutaneous coronary intervention (PCI) led to vessel perforation. Surgical intervention successfully retrieved the fractured guide wire, highlighting the need for caution with specific lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Guide wires are essential tools in PCI, but complications like fracture can occur.
- Fractured guide wires pose a significant risk, potentially leading to serious patient harm.
Purpose of the Study:
- To report a rare and serious case of hydrophilic guide wire fracture during PCI.
- To describe the mechanism of guide wire fracture and subsequent vessel perforation.
- To emphasize the importance of caution when using guide wires in complex coronary lesions.
Main Methods:
- A case report detailing a percutaneous coronary intervention (PCI) procedure.
- Description of the intra-procedural event of guide wire fracture.
- Explanation of the surgical intervention for guide wire retrieval and bleeding control.
Main Results:
- A hydrophilic guide wire fractured during PCI in a patient with a tortuous, calcified right coronary artery stenosis.
- The fractured guide wire segment perforated the coronary artery wall and ascending aorta.
- Successful surgical extraction of the fractured guide wire and cessation of bleeding were achieved.
Conclusions:
- Hydrophilic guide wire fracture is a rare but severe complication of PCI.
- The sharp edge of a fractured guide wire can cause significant vascular injury, including aortic perforation.
- Caution is advised when using polymer-jacketed guide wires in tortuous, calcified lesions during PCI.
Abstract:
We experienced a rare and serious case of fractured hydrophilic guide wire necessitating surgical intervention during percutaneous coronary intervention (PCI) for a tortuous and calcified stenosis in the proximal right coronary artery. An 85-year-old female presented to our hospital and was diagnosed as having unstable angina. A 0.014 in. hydrophilic guide wire (HI-TORQUE WHISPER MS Guide Wire™, Abbott Vascular, Abbott Park, IL, USA) was fractured during PCI trying to pass a microcatheter Corsair™ (ASAHI INTEC, Seto, Japan). During the procedure to retrieve the retained guide wire, the distal segment of the fractured guide wire penetrated the atherosclerotic coronary wall and ascending aorta unexpectedly. The surgical procedure could be performed successfully by extracting the fractured guide wire segments and stopping the bleeding. The edge of a hydrophilic guide wire that is fractured by friction between the microcatheter and guide wire is extremely sharp and can perforate both the atherosclerotic coronary vessel wall and aortic wall. Caution should be exercised when using such a device in combination with a polymer-jacketed wire at an acute angulated and calcified lesion. <Learning objective: Guide wires are the most common devices for interventional cardiologists. Guide wire fracture is a rare complication, but cardiologists should be well informed about it. This case report presents a detailed situation of hydrophilic guide wire fracture and penetration of coronary artery and even the aorta and discusses the mechanism.>.
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