Retained Coronary Guidewire With Proximal Systemic Extension Requiring Emergent Coronary Artery Bypass Grafting

Retained coronary guidewire fracture with proximal systemic extension is a rare but potentially life-threatening complication of percutaneous coronary intervention, occurring in approximately 0.02% to 0.08% of procedures.

A 66-year-old man with myocardial infarction underwent intravascular ultrasound-guided percutaneous coronary intervention for subtotal right coronary artery occlusion. High-pressure post-dilation of overlapping drug-eluting stents caused guidewire entrapment, fracture, and proximal extension into the ascending aorta and right subclavian artery. Following failed percutaneous retrieval, emergent coronary artery bypass grafting with aortotomy enabled extraction of 35.5 cm of guidewire while a 2.5-cm distal coronary fragment was intentionally retained. The patient recovered without recurrent ischemia and was discharged on clopidogrel and rivaroxaban.

Proximal systemic extension beyond the coronary ostium represented the inflection point for surgical escalation. A structured review of 23 published cases supports a practical location- and risk-based management framework.

Failed percutaneous retrieval with proximal systemic extension beyond the coronary ostium should prompt early multidisciplinary surgical evaluation.