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

Abstract

The incidence of anomalous origin of the coronary arteries varies between 0.2% and 1.2%; the anomalous right coronary artery accounting for 6--27% of all the cases. To date technical experience on angioplasty in patients with anomalous coronary arteries reported in the literature is limited. A major factor is the selection of the guiding catheter to access the anomalous origin and also to give good support during angioplasty. We report the details of angioplasty in a patient with a similar problem and the dilemma following a fractured segment of the guidewire retained in the coronary vasculature.

Rupture of guide wire during percutaneous transluminal coronary angioplasty, a case report

“…Entrapment or overrotatation of the distal tip of an angioplasty guide wire may lead to wire rupture [4,5]. Following this complication, two different situations can occur.…”

“…The guide wire remnants could lead to complications such as thrombosis, embolic phenomena and vessel occlusion. Whilst most authors recommend surgical extraction if percutaneous retrieval fails, there have been rare reports of wire fragments being left in situ without any adverse outcomes [3,4].…”

Pushing a catheter remnant into the coronary tree: Complication of the procedure? Maybe, but sometimes the fragment needs to be removed

“…In the event of failed interventional retrieval and persistent signs of ischemia, patients should be urgently referred to surgery. The success of surgery in this circumstance is determined primarily by the clinical status of the patient before the operation [3][4].…”

Conservative management of broken guidewire: Case reports

“…This then can lead to excessive bending with consequent fracture of the guidewire. 5 – 7 The Whisper wire, which was used in both cases described above, is noted to have the characteristics of being a full polymer wire with a hydrophilic coating. This decreases friction and allows for easier navigation through tortuous vessels at the expense of decreased tactile feedback and increased risk of perforation.…”