Case study: broken fractional flow reserve guidewire remained in the entire RCA

Clinical presentation

• 70-year-old male
• Risk factors: hypertension, hyperlipidemia, smoker (3-5 cigarets/day)
• History: angina pectoris (stent implantation in right coronary artery eight yeas before)
• Presentation: he was referred to  us because of preoperative evaluation (cholecystectomy)
• Medication: Aspirin 100mg , Lansoprazole 15mg, Pioglitazone 15mg, Amlodipine 5mg, Atorvastatin 10mg

Procedure

Coronary angiography - approach: right radial

Angiography revealed progression of stenosis in the proximal right coronary artery (RCA). To evaluate myocardial ischemia, we measured Fractional flow reserve(FFR).

Progression of stenosis

Progression of stenosis

FFR measurement

FFR guidewire was advanced in a small side branch. The guidewire was stuck in the side branch.

Stuck wire in side branch

Stuck wire in side branch

Broken guidewire

When we pulled the guidewire, the guiding catheter was disengaged and the guidewire fractured, 15cm broken guidewire remained in the entire RCA.

Percutaneous techniques

Although we tried microsnare and twisting wire technique, we couldn’t retrieve the guide wire.

Intravascular Ultrasound

Intravascular Ultrasound (IVUS) revealed the proximal edge of the guidewire was positioned in the small side branch.

Conclusion

• We found that it was impossible to retrieve the broken guidewire by percutaneous techniques.
• Surgical removal of the wire with vessel grafting was done.
• He was discharged from the hospital on the 12th postoperative day.