Technical aspects of entrapped coronary guidewire retrieval using rotational atherectomy device: A case series
Nikoloz Shekiladze1, Pratik B Sandesara1, Zaheed Tai2
1Andreas Gruentzig Cardiovascular Center, Division of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Rotational atherectomy (RA) successfully retrieved entrapped coronary guidewires in four complex cases when standard methods failed. This technique offers a safe and effective solution for guidewire entrapment during interventional procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary guidewire entrapment presents a significant challenge in percutaneous coronary interventions.
- Cases involving guidewire entrapment can lead to procedural complications and necessitate advanced retrieval techniques.
Purpose of the Study:
- To present four unique cases of entrapped coronary guidewires.
- To describe the successful application of rotational atherectomy (RA) for guidewire retrieval.
- To detail the technique and approach for managing complex guidewire entrapment.
Main Methods:
- Rotational atherectomy (RA) was employed using the Rotapro system (Boston Scientific).
- The procedure involved carefully cutting the entrapped guidewire within the coronary artery or aorta.
- Step-by-step procedural details for guidewire retrieval were documented.
Main Results:
- RA successfully facilitated the retrieval of entrapped coronary guidewires in all four presented cases.
- Entrapment occurred in the right coronary artery (3 cases) and left anterior descending artery (1 case).
- Complications included stent malformation and guidewire fracture with aortic extension, all managed by RA.
Conclusions:
- Rotational atherectomy is a safe and effective strategy for managing entrapped coronary guidewires.
- RA provides a valuable alternative when conventional guidewire retrieval methods are unsuccessful.
- This technique can resolve complex entrapment scenarios, including those with aortic involvement.
Background:
This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure.
Case Summary:
Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires.
Discussion:
Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
