Paul Mathews
Consultant Interventional Cardiologist, Moulana Hospital, Mysuru - Ooty Rd, Perintalmanna, Kerala 679322, India.
Eur Heart J Case Rep. 2024 Jul 23;8(8):ytae341. doi: 10.1093/ehjcr/ytae341. eCollection 2024 Aug.
Entrapment and fracture of the coronary guidewire are rare but major complications of percutaneous coronary intervention (PCI). The incidence of these complications is reported to be <1%.
A 52-year-old male patient with diabetes and dyslipidaemia presented with posterior wall myocardial infarction. An angiogram revealed occlusion in the left circumflex (LCX) artery. Attempts to pass a guidewire through the lesion led to its entrapment and eventual fracture. Several techniques and manoeuvres failed to retrieve the fractured guidewire, which remained lodged in the LCX. An endovascular snare catheter also proved unsuccessful. The fragment was eventually removed using the triple-wire technique, although this caused coronary perforation and dissection. The perforation was identified and stented. A subsequent stent addressed a dissection in the left main/left ascending artery area, likely caused by the coronary snare. These interventions were crucial in stabilizing the patient's condition, leading to recovery with a left ventricular ejection fraction of 50% and a viable LCX artery. The patient exhibited an uneventful progression at the 1-year follow-up.
Coronary guidewire fracture during PCI is a rare event often associated with coronary calcifications. Percutaneous removal remains the mainstay treatment for fragment removal; however, it carries risks. The triple-wire technique, a newer method that entangles and extracts the fractured guidewire without specialized equipment, was effective in removing the fragmented guidewire. If asymptomatic, leaving the wire is documented as a favourable approach. This case highlights that the triple-wire technique can effectively be used for the extraction of fractured guidewire fragments from the coronary vessels.
冠状动脉导丝陷入和断裂虽罕见，但却是经皮冠状动脉介入治疗（PCI）的严重并发症。据报道，这些并发症的发生率<1%。
一名52岁男性患者，患有糖尿病和血脂异常，出现后壁心肌梗死。血管造影显示左旋支（LCX）动脉闭塞。试图使导丝穿过病变部位导致导丝陷入并最终断裂。多种技术和操作未能取出断裂的导丝，其仍留在LCX中。血管内圈套导管也未成功。最终采用三线技术取出了碎片，尽管这导致了冠状动脉穿孔和夹层。穿孔被识别并置入了支架。随后的支架处理了左主干/左前降支动脉区域的夹层，可能是由冠状动脉圈套器所致。这些干预措施对稳定患者病情至关重要，患者得以康复，左心室射血分数为50%，LCX动脉存活。患者在1年随访中病情进展顺利。
PCI期间冠状动脉导丝断裂是一种罕见事件，常与冠状动脉钙化有关。经皮取出仍然是碎片取出的主要治疗方法；然而，它存在风险。三线技术是一种无需专门设备即可缠绕并取出断裂导丝的较新方法，在取出断裂导丝方面有效。如果无症状，将导丝留在原位被记录为一种有利的方法。本病例强调三线技术可有效地用于从冠状动脉血管中取出断裂的导丝碎片。
