How should I treat a patient to remove a fractured jailed side branch wire?

BACKGROUND

A 53-year-old female was sent for diagnostic angiography after successful reperfusion therapy for an anterior ST-elevation myocardial infarct. The culprit lesion was a LAD/D1 bifurcation stenosis.

INVESTIGATIONS

Coronary angiography, intravascular ultrasound.

DIAGNOSIS

Left anterior descending artery/first diagonal artery bifurcation stenosis, fractured jailed side branch wire.

TREATMENT

Provisional stenting strategy for bifurcation stenosis. Consideration of surgical and percutaneous options to retrieve fractured, jailed, side branch wire. Wire and balloon catheter wrap technique for retrieval of fractured wire.