Case study: successful retrieval of trapped elongated broken guidewire using Mother-and-child with trapping balloon technique

Clinical presentation

• 48-year-old male
• Risk factors: Hypertension,dyslipidemia, current smoking
• Presentation: unstable angina pectoris
  • TTE showed LVEF of 40% with severe hypokinesis of inferior and inferolateral segments with preserved wall thickness
  • Coronary angiography was performed radially which revealed severe triple vessels disease with CTO of distal segment of right coronary artery
  • Calculated SYNTAX score was 25 (intermediate)
  • The patient strongly denied undergoing CABG due to no family support

We planned to perform PCI of the right coronary artery first.

1st attempt of CTO of RCA

• 6Fr XBRCA guide for the right coronary artery from right femoral artery
• 6Fr JL3.5 catheter for contralateral injection from right radial artery
• Antegrade wire: Pilot 50 and Fielder XT wires with Finecross microcatheter (seesaw wiring technique) had failed to advance crossing distal right occlusion
• We changed to do PCI of left anterior descending artery

PCI to left anterior descending artery

XB 3.0 guide, Pilot 50 wire, balloon 2.5 x 15mm at 12 ATM

XB 3.0 guide, Pilot 50 wire, balloon 2.5 x 15mm at 12 ATM

BES 3.0 x 18mm at 16 ATM, post dilation with NC, 3.0 x 15mm at 18 ATM

BES 3.0 x 18mm at 16 ATM, post dilation with NC, 3.0 x 15mm at 18 ATM

Procedural time 1.15 hour, contrast 170 cc, fluoroscopic time 33.58 minutes

Procedural time 1.15 hour, contrast 170 cc, fluoroscopic time 33.58 minutes

• Patient was discharged from hospital on next day without complication
• Staged PCI of right coronary artery was scheduled

Procedure

2nd attempt of CTO of RCA

• A 0.010” Fielder XT wire with Finecross microcatheter
• Tried to advance antegrade wire through CTO body
• Suddenly, tip of wire became stuck and failed to move in CTO segment
• When pulled out the wire, the tip still got stuck at the lesion but sharp got elongated
• Fluroscopy revealed nearly broken of tip of wire
• We tried to advance low profile balloon 1.2 x 12mm for dilating of CTO segment but failed to release entrapped wire

Consult the editorial webcast of this clinical case during the EuroPCR 2018 session on Lost and found I: management of broken guidewires

• Using anchoring balloon to deliver 5Fr Heartrail 120cm to mid right coronary artery (Mother-and-child technique)
• Using balloon 2.0 x 12mm trapped the wire inside the catheter, we removed all system components out of the coronary artery
• Successfully retrieval trapped wire
• Angiogram showed spasm of mid segment and improved after nitroglycerine
• We concluded the procedure and scheduled patients for staged PCI using retrograde technique

Conclusion

• Procedural time 1.15 hour
• Contrast 170 cc
• Fluoroscopic time 48.15 minutes
• Patient was discharged from hospital on next day without complication