Case of retained guide wires traversing anatomical boundaries with neurological and cardiac morbidity

Area of Science:

• Cardiology
• Neurology
• Interventional Radiology

Background:

• A 69-year-old female patient with a history of cardiac and neurological issues presented with multifocal cerebral infarcts.
• The infarcts were attributed to embolization from retained guide wires, necessitating urgent retrieval.

Observation:

• One guide wire was intracardiac, while the second had migrated through major vascular structures, crossing anatomical boundaries.
• The patient spontaneously expectorated a 35 cm wire, which was removed using a video laryngoscope prior to planned surgery.
• A second, 7 cm wire penetrated the right ventricular myocardium, requiring emergency retrieval.

Findings:

• Successful retrieval of both retained guide wires was achieved through minimally invasive techniques.
• The 35 cm wire was removed via video laryngoscopy.
• The 7 cm wire was extracted via emergency left anterior mini-thoracotomy.

Implications:

• This case highlights the potential for serious neurological complications from retained intravascular foreign bodies.
• Demonstrates the successful application of diverse retrieval techniques, including laryngoscopy and mini-thoracotomy, for complex foreign body removal.
• Emphasizes the importance of vigilance and prompt intervention in managing retained guide wires to prevent further embolic events and anatomical breaches.