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Successful Removal of a Fractured Guidewire During Percutaneous Coronary Intervention With Orbital Atherectomy
Harish Ravipati1, Edo Kaluski2
1Guthrie Cortland Medical Center, Cortland, New York, USA.
Insights
Guidewire entrapment during percutaneous coronary intervention (PCI) is rare. Orbital atherectomy successfully managed a fractured guidewire in calcific in-stent restenosis, preventing cardiac complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Guidewire entrapment or fracture is a rare but serious complication during percutaneous coronary intervention (PCI).
- Prompt management is crucial to avoid adverse cardiac outcomes.
Background:
Guidewire entrapment or fracture is a rare complication during percutaneous coronary intervention (PCI). Timely management is warranted to prevent poor cardiac outcomes.
Case Summary:
An 83-year-old man with coronary artery disease was referred for PCI given severe left anterior descending disease and right coronary artery disease (RCA). During PCI of in-stent restenosis of the RCA, the 0.014-inch Versaturn guidewire (Abbott) was entrapped in the coronary calcium within a prior stent, and the tip fractured. The wire entrapment led to a technically complex procedure, which was treated with orbital atherectomy and stenting of the RCA to cover the entrapped fractured wire.
Discussion:
Previous reports have highlighted the use of rotational atherectomy in coronary artery remodeling and the management of entrapped or fractured guidewires. This is the first reported case employing orbital atherectomy to manage an entrapped fractured guidewire within calcific in-stent restenosis.
Take-Home Message:
Guidewire entrapment within critical calcific lesions creates considerable difficulty, which can lead to cardiac complications, and it can be managed with orbital atherectomy and stenting.
