The successful retrieval of a broken guide wire from the diagonal branch of the left anterior descending coronary artery complicated by partial stent rolling

Introduction

Percutaneous coronary interventions (PCIs) are relatively safe, and the complication rate is low in comparison to cardiac surgery revascularization. The incidence of broken or retained PCI equipment is about 0.1–0.8% [1]. We report a successful retrieval of a fractured guide wire by using a percutaneous catheter Amplatz GooseNeck Snare and Microsnare Kit (Covidien, Plymouth, USA), which was complicated by stent deformation in the form of rolling up its distal part after retracting a piece of the guide wire. This artificial damage to the implanted stent was initially ineffectively treated with balloon angioplasty and finally successfully with double drug-eluting stent (DES) deployment.

Case report

The patient was a 60-year-old man, with effort angina class II, admitted to our hospital for elective PCI of the left main coronary artery (LMCA) and the left anterior descending coronary artery (LAD). The patient was a heavy smoker for more than 40 years, with arterial hypertension, heart failure, hypercholesterolemia, obesity, and osteoarthritis of the spine. The patient had been diagnosed with myocardial infarction 2 weeks before, and primary PCI of the right coronary artery with DES implantation was performed previously. His prior myocardial infarction was complicated by non-sustained ventricular tachycardia including torsades de pointes. Angiography revealed significant lesion in the distal LMCA and proximal LAD, which were confirmed by intravascular ultrasound (IVUS) (Figures 1 A, 2 A). The patient was qualified for the second stage of endovascular revascularization by heart team council. At admission the patient was stable, without clinical symptoms, cardiopulmonary and respiratory aligned. A transthoracic echocardiogram showed a normal left ventricular fraction (50%) with hypokinesis of the posterior wall.
We performed PCI of LMCA/LAD using the femoral approach. The 7 Fr extra back-up 3.5 (Medtronic, Inc. Minneapolis, Minnesota, USA) guide catheter was introduced. Then BMW Elite and Universal II (Abbott Vascular, Santa Clara, California, USA) guide wires were introduced into the LAD, diagonal branch (Dg) 1 and Dg2. We implanted directly DES Xience PROX (Abbott Vascular, Santa Clara, California, USA) 3.0 × 28 mm in the LAD (Figure 1 B). Afterwards, post-dilatation was carried out with the non-compliant balloon catheter 3.5 × 12 mm EmergeTM (Boston Scientific, Marlborough, MA, USA). Additional post-dilatation was...


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