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Retained Coronary Guidewire Extending to the Right Axillary Artery
Amre Ghazzal1, Tariq Sallam1, Laith Ali1
1Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
Insights
A retained guidewire after percutaneous intervention for myocardial infarction was successfully retrieved surgically. This case highlights a rare complication and its management in interventional cardiology.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely intervention.
- Percutaneous coronary intervention (PCI) is a common treatment for STEMI.
- Complications, though rare, can occur during PCI procedures.
Observation:
- A 56-year-old female experienced a retained guidewire in the left circumflex artery after PCI for inferior STEMI.
- The guidewire extended from the left circumflex artery through the ascending aorta into the right axillary artery.
- Cardiac CT imaging delineated the complex path of the retained guidewire.
Findings:
- Initial percutaneous retrieval was deferred due to stent damage risk.
- The patient was discharged on triple antithrombotic therapy (Aspirin, Clopidogrel, Apixaban) for 3 months.
- No bleeding or thromboembolic complications were observed during follow-up.
Implications:
- Surgical retrieval of the retained guidewire was ultimately performed along with coronary artery bypass grafting (CABG).
- This case underscores the importance of careful guidewire management during PCI.
- Multidisciplinary collaboration between interventional cardiology and vascular surgery is crucial for managing complex procedural complications.
Abstract:
This is a case of a 56-year-old female who presented with inferior ST segment elevation myocardial infarction (STEMI), treated with percutaneous intervention (PCI), which was complicated by a retained guidewire extending from left circumflex artery (at location of obtuse marginal (OM) stent) through the ascending aorta, the right brachiocephalic artery and into the right axillary artery. Patient underwent cardiac CT, with maximum intensity projection image showing the course of the retained guidewire. Percutaneous retrieval was deferred due to risk of damaging the stent, and the patient initially deferred coronary artery bypass (CABG) and surgical retrieval as. She was discharged on triple therapy with Aspirin, Clopidogril and Apixaban for 3 months with no bleeding or thromboembolic complications on a 3-month follow up with cardiology clinic, during which rediscussion of risks and benefits of CABG and surgical retrieval or retained wire took place with the patient. Patient agreed to undergo the procedure and guidewire was retrieved surgically and CABG was done.
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