Fractured and retained guide‐wire fragment during coronary angioplasty—unforeseen late sequelae

Abstract

During a difficult coronary angioplasty, the tip of the guide wire became inadvertently wedged in a distal vessel, fractured, and retained in situ. Because of the otherwise successful nature of the angioplasty and the patient's great risk for cardiac surgery, it was elected to leave the wire fragment in place. Recurrence of symptoms led to recatheterization, which in addition to restenosis of the original angioplasty site showed diffuse narrowing of the arterial segment that contained the retained wire fragment. This occurred despite systemic anticoagulation with Coumadin in the interval between procedures. Thus retained guide wire fragments in patent coronary arteries may cause arterial narrowing despite systemic anticoagulation.

Entrapped catheter in the left ventricular posterior venous radicle of the coronary sinus in a case of hemianomalous pulmonary venous connection of left pulmonary veins to coronary sinus

“…Though coronary venous catheter entrapment is unreported, the incidence of entrapment or fragmentation of coronary artery angioplasty hardware ranges from 0.2% to 0.8% [3][4][5][6], actually just 39 reported cases in the past 13 years [3]. Of these, in 8 cases, the wire fragments were left in situ.…”

Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting

“…Although rare coronary guide wire fracture has been described previously, in some cases, medical management has been reported to be used safely , whereas in other cases, adverse sequelae are described . Surgical removal has been necessary in several reports; however, percutaneous strategies such as using a snare or even deploying a coronary stent within the guiding catheter to trap the wire have been reportedly successful.…”

“…Various options and devices are available including the use of a snare and vascular or cardiac surgery . Adverse sequelae have been described from retained fractured wire fragments, including accelerated restenosis , thrombosis , and perforation .…”

Percutaneous Coronary Intervention to Anomalous Right Coronary Artery and Retained Piece of Guidewire in the Coronary Vasculature

“…A late follow‐up of 5 patients with wire segments retained for an extended time within the coronary circulation had no sequelae attributable to the PTCA component debris. Use of oral anticoagulation following retained wire segments in patent arteries has not been shown to prevent long‐term sequelae of arterial narrowing 8 …”