Coronary wire loss: part of jailed wire behind stent struts confined to the coronary artery (free wire distal to the stent)

Coronary guidewire loss complications

You are faced with a lost guidewire – a jailed wire confined to the coronary artery behind the stents struts or is seen to be free and distal to the stent itself: How do you manage this type of complication? This section offers the different clinical approaches this situation requires…

Introduction

This diagram illustrates how to manage wire loss complications in the event that part of the jailed wire is confined to the coronary artery and behind the stent struts or when the free wire is seen to be distal to the stent itself. The evaluation of these types of wire loss are explained, with careful attention to the different points that could determine when either stenting or attempted device removal is warranted. Understanding when and why certain techniques should be employed are discussed and the microsnare and multiwire approaches are illustrated. The question of when more conservative approaches or surgery should be employed are considered as well.

Management overview

Key messages:

• Considering stenting the left main if you have adequate skills and material according to the guideline recommendations
• Elective procedure: if you want to consider surgery you have to do it on the same day (issue with the DAPT)

Case library

Clinical case on crush technique by A. Muhammad et al.: Guidewire core fracture

Clinical case on crush technique by G. Leithold: Intracoronary guidewire fracture

More clinical cases will become available shortly!