Real-time IVUS-guided retrieval of a coronary retained guidewire fragment: A case report

Percutaneous coronary intervention is generally safe, but rare complications such as guidewire fracture can occur and may lead to thrombosis, embolism, vessel injury, or myocardial ischemia. We report the case of a 58-year-old male patient with 2-vessel coronary artery disease who underwent coronary stenting of the left anterior descending and circumflex arteries in another institution. During the index procedure, the guidewire fractured at the bifurcation between the left anterior descending artery and the first diagonal branch. One week later, the patient presented at our institution with recurrent chest pain and a second procedure was performed to retrieve the retained fragment. Real-time intravascular ultrasound imaging was used to visualize the fragment and perform targeted retrieval using a gooseneck snare introduced into the vessel. The fragment was successfully removed without altering the stent position, with uneventful follow-up. This case highlights that real-time IVUS visualization can modify procedural strategy for such complication by improving localization of retained intravascular material and allow safer percutaneous retrieval compared with fluoroscopy alone, potentially reducing the need for surgical intervention.