Coronary guidewire loss: distal wire fragment fracture in the coronary circulation

Coronary embolised device complications

Though rare, the complication of coronary guidewire loss exists and can be seen to occur in several different ways: when part of a jailed wire protrudes into the aorta beyond the stent struts themselves, when the jailed wire is confined to the coronary artery alone or when the free section in situ of the intracoronary wire segment is fractured.

This section illustrates the management of these complications and begins by taking into account the age and frailty of the patient, the DAPT regime as well as the different imaging procedures for fully defining the nature of the complication. The position of the lost wire needs to be accurately determined, as well as the wire length and thickness. The different tools and approaches that can be employed are explored, including snaring or multiwire techniques, wire aspiration and stenting. More conservative options and surgery are also considered.

PCR Complications Team: Patrick Calvert, Eric Eeckhout, Michael Haude and Olivier Muller

Medical assistant: Julien Adjedj, Stephane Fournier

The 3 main scenarios that can be encountered are:

1. Part of jailed wire behind stent struts, protruding in aorta
2. Jailed wire confined to the coronary artery
3. Free intracoronary fractured wire segment

PART OF JAILED WIRE BEHIND STENT STRUTS	Guidewire loss when the jailed wire is seen to protrude into the aorta: learn the step-by-step approach to managing this complication here.	JAILED WIRE BEHIND STRUTS
JAILED WIRE CONFINED TO CORONARY ARTERY (CA)	How do you manage a guidewire loss when part of the jailed wire is behind the stent struts in the coronary artery or the free wire is seen to be distal to the stent? Learn how to deal with this complication here.	JAILED WIRE IN CA
PART OF FREE WIRE IN SITU	Want to learn how to deal with complications arising from a free wire lost in situ, a free intracoronary fractured wire segment – or avoid this situation in the first place? This section will tell you how.	FREE WIRE IN SITU

Each type of complication is presented in three parts, namely:

• Part 1 - Introduction
• Part 2 - Management algorithm/decision tree and additional links
• Part 3 - Case library

In addition to this complication management resource, further cases on complications are available on the website in the Topics section

Key messages

Factors at increased risk for wire fracture:

• Extended calcification
• Greater angulation of the side branch
• Length of jailed wire segment
• Wire thickness (the thinner the wire the more fragile it is)
• Jailing wires between two stents

Preventative measures:

• Do not apply excessive force, advance a microcatheter or other over-the-wire balloon to the proximal edge of the stent that jails the wire