Lee Hung-Hao, Hsu Po-Chao, Lee Wen-Hsien, Chu Chun-Yuan, Su Ho-Ming, Lin Tsung-Hsien, Voon Wen-Chol, Lai Wen-Ter, Sheu Sheng-Hsiung, Chiu Cheng-An
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital; ; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Acta Cardiol Sin. 2016 Sep;32(5):616-618. doi: 10.6515/acs20151115a.
A 66-year-old male was treated percutaneously for a bifurcation lesion of the left anterior descending coronary artery by provisional stenting using the jailed wire technique. After successfully stenting the main branch, retraction of the looped main branch guidewire was impossible. After using an intravascular ultrasound we discovered the guidewire was entangled with a stent strut. Thereafter, the proximal stent elongated after retraction. With the support of an over-the-wire microcatheter, we finally pulled out the entrapped guidewire. This rare complication should remind physicians that it is important to prevent the distal guidewire from being looped while retracting it through a stent, regardless of whether it is in the side branch or main vessel. If the guidewire becomes entangled with a stent, a microcatheter or low-profile balloon can be advanced to rescue it before the stent is damaged. Furthermore, the microcather should be maintained after successful retraction of the entangled guidewire to facilitate further wiring and subsequent rescue angioplasty as necessary.
一名66岁男性因左前降支冠状动脉分叉病变，采用“拘禁导丝”技术行临时支架置入术进行经皮治疗。在成功对主支进行支架置入后，无法回撤成袢状的主支导丝。使用血管内超声后，我们发现导丝与支架小梁缠结在一起。此后，近端支架在回撤后拉长。在过线微导管的支撑下，我们最终拔出了被困的导丝。这种罕见的并发症应提醒医生，无论导丝位于侧支还是主血管，在通过支架回撤导丝时，防止导丝远端成袢非常重要。如果导丝与支架缠结，可以在支架受损前推进微导管或低轮廓球囊进行补救。此外，在成功回撤缠结的导丝后，应保留微导管，以便在必要时便于进一步导丝操作和后续补救性血管成形术。
