Impact Factor: 1.4

Article

Images in cardiology

REC Interv Cardiol. 2019;2:136-137

Optical coherence tomography assessment of intracoronary guidewire fractures

Rotura de guía intracoronaria evaluada por tomografía de coherencia óptica

Gunnar Leithold, Javier Lacunza-Ruiz, and Juan García de Lara

Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain

One 72-year-old male who recently suffered from a non–ST-segment elevation myocardial infarction (NSTEMI) underwent a staged percutaneous coronary intervention (PCI) due to significant stenosis of his mid left anterior descending (LAD) and mid left circumflex (LCX) arteries (figure 1A; red arrow). After placing one hydrophilic Hi-Torque intracoronary guidewire into the LCX, one drug-eluting stent (DES) was deployed uneventfully (figure 1B and figure 1C). However, we were unable to extract the guidewire afterwards probably due to entrapment with a calcified plaque. The stronger traction resulted in the partial fracture of the guidewire followed by the disruption of the coils (figure 1D, white arrows; the red arrow points to a second inserted guidewire). Retrieval was unsuccessfully attempted using different techniques like the snare loop technique and the twisting wire technique (video 1 of the supplementary data). After the uncomplicated stenting of the mid LAD, we conducted an optical coherence tomography (OCT). A three-dimensional reconstruction showed remains of the broken wire (figure 2; blue arrows) coming out of the LCX (figure 2; yellow asterisk) and into the left main stem (LMS) and proximal LAD with presence of adhered and free-floating thrombotic material as shown in the cross-sectional views (figure 3A and figure 3B; blue arrows point to the wire remains; the yellow arrow points to the thrombotic material; MLA, minimal lumen area; video 2 of the supplementary data). We immediately proceeded to eliminate the uncoiled filaments from the circulation by deploying one DES into the distal LMS and the proximal LAD. The control OCT conducted showed the wire remains trapped by the struts of the stent against the vessel wall (figure 3C; white arrow: wire remains, highlighted in red-framed box; red asterisks: stent struts).

Figure 1

Figure 2

Figure 3

SUPPLEMENTARY DATA

Video 1. Leithold G. DOI: 10.24875/RECICE.M19000020

Video 2. Leithold G. DOI: 10.24875/RECICE.M19000020

Corresponding author: Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, Carretera Madrid Cartagena s/n, 30120 El Palmar, Murcia, Spain.
E-mail address: gunnar.leithold@gmail.com (G. Leithold).

Original articles

Recic Uk 23 065 F3

Editorials


Original articles

Recic Uk 23 072 F3
Recic Uk 23 099 F3
Recic Uk 23 044 F1

Editorials

Recic 23 092 F2

Original articles


Special articles

Recic Uk 23 075 F2

Debate

Debate: Ablation vs lithotripsy in calcified coronary lesions

Recic 23 102 F1
Recic 23 100 F1