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[Extraction of a broken intracoronary PTCA guide wire perforating the circumflex artery, using a Dotter retrieval
Insights
Coronary artery perforation during angioplasty is dangerous. A broken guidewire was successfully removed with a Dotter catheter, avoiding emergency surgery and only causing minor effusion.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery perforation is a rare but serious complication of percutaneous transluminal coronary angioplasty (PTCA).
- Standard management for significant coronary perforation involves immediate surgical intervention to prevent pericardial tamponade.
Observation:
- A case of coronary artery perforation caused by a broken intracoronary guide wire during PTCA is presented.
- The broken guide wire was successfully retrieved using a Dotter intravascular retriever catheter.
Findings:
- The successful extraction of the broken guide wire prevented the need for emergency surgery.
- The patient developed only a small pericardial effusion, which did not require pericardiocentesis.
Implications:
- Emergency surgery may not be inevitable for all cases of coronary artery perforation, particularly those involving thin intracoronary guide wires.
- The use of intravascular retrieval devices can be a safe and effective alternative to surgery in select cases of coronary guide wire perforation.
Abstract:
Coronary artery perforation is a rare but potentially lethal complication during percutaneous transluminal coronary angioplasty (PTCA). To avoid pericardial tamponade, it has been suggested that perforating wires or balloons should not be withdrawn and that the patient should be transferred immediately to surgery. We report a case with a perforating and broken intracoronary guide wire which was successfully extracted using a Dotter intravascular retriever catheter. The only consequence was a small pericardial effusion not requiring pericardial puncture. Thus, emergency surgery is not inevitable after coronary artery perforation caused by thin intracoronary guide wires.