Coronary wire loss: part of free wire, in situ - free intracoronary fractured wire segment
Coronary guidewire loss complications
Do you know how to react clinically when you have guidewire loss involving part of a free wire in situ, a free intracoronary wire segment? Where to begin…and what preventive measures to take to avoid wire fracture in the first place? Learn more in this section…
Table of content
Introduction
This section focuses on the management of wire loss complications when part of the free wire is seen in situ with a free intracoronary wire segment. Beginning with the procedure for evaluating the rupture zone using imaging techniques such as IVUS or OCT, different options are illustrated for the retrieval of the lost wire including snaring, stenting, wire aspiration or trapping. A conservative approach is also discussed. Those factors which increase the risk for wire fracture initially are considered including increased calcium, side branch angulation, different wire lengths and thickness as well as preventive measures to help avoid this complication in the first place.
Management overview
- Snare technique - GooseNeck: When retrieving a lost guidewire, the snare technique is feasible with a GooseNeck snare and it is easier when the fragment is located proximally in a coronary artery. Discover more about this technique here.
- Wire aspiration using thrombectomy device: Measures which can be taken to prevent guidewire-related complications are explained as well as the recommended steps to perform wire aspiration by using a thrombectomy device.
- Trapping guide extension catheter technique: If a part of the wire fragment is still in the guiding catheter, it could be removed entrapping it between an inflated balloon in the guiding catheter and the wall of catheter. If the fragment inside the guiding catheter is shorter, it’s possible to advance a guiding catheter extension. Learn how!
- Multiwire technique: The multiwire retrieval technique involves inserting one or two wires next to the fragment and twisting the wires together. The fragment may become entrapped in those wires and therefore be removed.
Key messages
- Use imaging technique to identify the rupture zone
- Individualised patient assessment
Additional links
References - Guidewire loss complications
Case library
Clinical case on multiwire technique by J. Maia: Twin guidewire method
Clinical case on surgery by Shunta Taminishi et al.: Broken fractional flow reserve GW
Clinical case on guide extension catheter technique by K. Meemook: Trapped elongated GW
More clinical cases will become available shortly!
Disclaimer
This case report does not reflect the opinion of PCR or PCRonline, nor does it engage their responsibility.
