Department of center for coronary heart disease, Fu Wai Yunan Cardiovascular Hospital, Kunming, China.
Medicine (Baltimore). 2024 Apr 19;103(16):e37842. doi: 10.1097/MD.0000000000037842.
Guidewire fracture is one of the biggest risks of percutaneous coronary intervention, twisting wire technique is very useful for retrieving the fractured wire, but the potential risks have been inadequately reported. Herein, we present a case of retrieval of guidewire fragments using the twisting wire technique that causes coronary perfusion.
A 37-year-old male patient was admitted to our hospital for elective percutaneous coronary intervention of the left circumflex coronary artery.
For chronic total occlusion of the distal left circumflex coronary artery, antegrade recanalization by wire escalation, and parallel wire techniques were attempted. However, we shockingly found that the BMW guidewire, anchored in the right coronary artery, spontaneously fractured from the proximal right coronary artery, and a lengthy fragment of the guidewire remained in the coronary.
DIAGNOSES, INTERVENTIONS, AND OUTCOMES: Many attempts were made to retrieve the remnant guidewire including the twisting wire technique, which leads to the perforation of the coronary.
Finally, percutaneous retrieving procedures were stopped in favor of surgical extraction via a small coronary arteriotomy. This procedure was successful.
To the best of our knowledge, the present case is the first reported spontaneous fracture of the guidewire. Leaving such a lengthy remnant guidewire in the artery, or leaving stenting over the wire, would impose a high risk of coronary thrombosis, perforation, and embolization. Yet, the perforation of the artery that occurred in this case, which could have had life-threatening consequences, resulted from our attempts to retrieve the guidewire using the twisting wire technique.
导丝断裂是经皮冠状动脉介入治疗（PCI）最大的风险之一，扭丝技术对于取回断裂的导丝非常有用，但潜在风险尚未得到充分报道。在此，我们报告了一例使用扭丝技术导致冠状动脉灌注的导丝碎片取回的病例。
一名 37 岁男性患者因择期行左回旋支冠状动脉 PCI 被收入我院。
对于左回旋支远段慢性完全闭塞，尝试采用导丝升级和并行导丝技术进行顺行再通。然而，我们震惊地发现，BMW 导丝在右冠状动脉内固定，自发地从近段右冠状动脉断裂，导丝的很长一段残留在冠状动脉内。
诊断、干预和结果：尝试了多种方法来取回残留的导丝，包括扭丝技术，但导致了冠状动脉穿孔。
最后，经皮取回程序被停止，转而通过小冠状动脉切开术进行外科提取。该程序成功。
据我们所知，本例是首例报道的导丝自发断裂。在动脉内留下如此长的残留导丝，或在导丝上进行支架置入，将增加冠状动脉血栓形成、穿孔和栓塞的高风险。然而，本例中发生的动脉穿孔，如果不及时处理，可能会有生命危险，这是由于我们试图使用扭丝技术取回导丝所致。
