Leibundgut Gregor, Achim Alexandru, Krivoshei Lian
Department of Cardiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.
Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, Liestal 4410, Switzerland.
Eur Heart J Case Rep. 2023 Jul 12;7(8):ytad311. doi: 10.1093/ehjcr/ytad311. eCollection 2023 Aug.
Guidewire fracture and loss is a rare but well-known and feared complication of percutaneous coronary interventions. With the increasing number of complex coronary interventions and procedures for chronic total occlusions, operators face new challenges and boundaries, and the need for solutions to otherwise rare complications is increasing.
We have developed a simple and practical method for retrieving fractured and lost guidewires, called the 'knuckle-twister' technique. This article summarizes seven cases in which guidewires lost in the coronary vasculature have been successfully removed and describes this technique in detail. The goal was to gather different clinical scenarios: free wire lost , wire jailed behind stent struts, wire in small branches, part of the wire protruding into the aorta, 'invisible' guidewire microfilaments/coils, etc.
The innovation of the knuckle-twister consists in folding a polymer-jacketed guidewire and transforming it into an open lasso that tightens when twisted. , its grip strength and pulling force was tested and exceeded 1.5 kg. Moreover, in all cases, the lost material could be efficiently and quite rapidly retrieved with this simple and highly reproducible technique.
Broken guidewires that were lost in the coronary vasculature can be safely retrieved with this novel and simple technique requiring no special safety equipment.
导丝断裂和丢失是经皮冠状动脉介入治疗中一种罕见但广为人知且令人担忧的并发症。随着复杂冠状动脉介入治疗和慢性完全闭塞病变手术数量的增加，术者面临新的挑战和局限，对于原本罕见并发症解决方案的需求也在增加。
我们开发了一种简单实用的方法来取出断裂和丢失的导丝，称为“指关节扭转器”技术。本文总结了7例成功取出冠状动脉血管内丢失导丝的病例，并详细描述了该技术。目的是收集不同的临床情况：游离导丝丢失、导丝被困在支架小梁后、导丝在小分支内、导丝部分突出至主动脉、“隐形”导丝微丝/线圈等。
指关节扭转器的创新之处在于将包裹聚合物的导丝折叠并将其转变为一个扭转时收紧的开放式套索。对其握持力和拉力进行了测试，超过了1.5千克。此外，在所有病例中，使用这种简单且高度可重复的技术能够高效且相当迅速地取出丢失的材料。
使用这种无需特殊安全设备的新颖简单技术，可安全取出冠状动脉血管内丢失的断裂导丝。
