A missing coronary guidewire mimicking aortic dissection—a case report

Abstract

Background A retained coronary guidewire following coronary angiography is an extremely rare complication. We present a case of a retained coronary guidewire from a percutaneous coronary intervention done 2 years ago. Case summary An 80-year-old asymptomatic man with a history of ischemic heart disease and moderate aortic stenosis presented to the echocardiography lab for routine follow up. Transthoracic echocardiography (TTE) showed Moderate aortic stenosis and a suspected linear echogenic structure in the ascending aorta. trans-esophageal echocardiography (TEE) was performed to reveal a mobile and linear echogenic structure originating from the sinuses of Valsalva/Sinotubular junction (STJ) and extending to the ascending aorta. An ECG gated cardiac computed tomography (CT) was performed and showed A linear well-defined structure originating from the ostium of the LM coronary artery and extending to the ascending aorta - a coronary guidewire from an earlier procedure. A second look on the last invasive coronary angiography record demonstrated the same finding. A multidisciplinary heart team discussion was obtained and concluded that the risk of surgical or endovascular intervention outweighed the potential benefit. The patient was discharged home for a close clinical and echocardiographic follow up. Conclusion A retained coronary guidewire is a rare complication that operators should be aware of. Management should be case-specific depending on clinical presentation.