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Guidewire transection during rotational coronary atherectomy due to guide catheter dislodgement and wire kinking
K Foster-Smith1, K N Garratt, D R Holmes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Rotational coronary atherectomy can treat calcified lesions, but guidewire transection is a risk. Proper guide catheter alignment is crucial to prevent this complication during the procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Rotational coronary atherectomy is a key intervention for severe calcified ostial coronary artery stenosis.
- Ensuring procedural safety and efficacy is paramount in complex coronary interventions.
Observation:
- A rare complication, guidewire transection, occurred during rotational atherectomy of a right coronary artery ostial lesion.
- Guide catheter dislodgement led to guidewire prolapse and kinking, ultimately causing transection by the atherectomy burr.
Findings:
- The severed guidewire fragment was successfully retrieved using a fixed-wire balloon catheter.
- This event highlights a specific risk associated with rotational atherectomy technique.
Implications:
- Maintaining coaxial alignment of the guide catheter is critical for preventing guidewire damage during rotational atherectomy.
- Operators must be vigilant for potential damage to radiolucent guidewires, especially in challenging anatomies.
Abstract:
Rotational coronary atherectomy is an effective treatment for calcified ostial lesions. We report a case of guidewire transection during rotational atherectomy of a right coronary artery ostial stenosis. Guide catheter dislodgement appeared to have caused prolapse and kinking of the guidewire. Advancement of the burr over the kinked wire resulted in transection. The wire fragment was retrieved successfully using an inflated fixed-wire balloon catheter. This report illustrates the importance of excellent coaxial guide catheter alignment with rotational atherectomy and suggests that operators be vigilant to possible damage to the radiolucent rotational atherectomy guidewire.