Raiders of the Lost Wire

C. Salazar, G. Tirado, Angela Mclnerney, L. Nombela‐Franco, I. Núñez-Gil
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引用次数: 1

Abstract

Introduction: An angiographic guidewire is a basic, yet essential piece of equipment in the interventional cardiologist’s armamentarium. Complications associated with angiographic guidewires can be catastrophic to the safe completion of a coronary procedure. In this article, the authors report a case of angiography guidewire fracture and explore the options for management of this rare but serious complication. Case presentation: A 77-year-old man with multiple cardiovascular risk factors was admitted with an anterior ST segment elevation myocardial infarction. Diagnostic angiography was performed via right radial access and revealed a subocclusive stenosis of the mid and distal left anterior descending artery (LAD) with thrombolysis in myocardial infarction 1 flow and a 70% stenosis of the proximal diagonal branch. Primary percutaneous coronary intervention was attempted and a HI-TORQUE Balance Middle Weight Universal II guidewire (Abbott Vascular Inc., Santa Clara, California, USA) was chosen. Guidewire manipulation was difficult because of significant calcification and tortuosity of the LAD. Consequently, the guidewire fractured and became trapped in the mid-LAD. The complication was ultimately resolved by stenting across the fractured guidewire and the patient was not afflicted by any adverse sequelae. Discussion: This case highlights a rare but potentially serious complication of coronary intervention. Proposed management varies from leaving the fractured wire in situ and stenting across it, to varying techniques for removing the fractured wire. However, no consensus exists as to the best strategy. The authors have therefore performed a review of the current literature and propose an algorithm for the management of this rare complication.
《夺宝奇兵
导读:血管造影导丝是介入心脏病专家的基本设备。与血管造影导丝相关的并发症对冠状动脉手术的安全完成可能是灾难性的。在本文中,作者报告了一例血管造影导丝骨折,并探讨了治疗这种罕见但严重并发症的方法。病例介绍:一名77岁男性,有多种心血管危险因素,因前ST段抬高型心肌梗死入院。通过右桡动脉通道进行诊断性血管造影,发现左前降支(LAD)中、远端闭塞性狭窄伴心肌梗死1血流溶栓,近侧斜支狭窄70%。我们尝试进行初级经皮冠状动脉介入治疗,并选择了一根HI-TORQUE Balance Middle Weight Universal II导丝(Abbott Vascular Inc., Santa Clara, California USA)。由于LAD明显的钙化和弯曲,导丝操作很困难。因此,导丝断裂并被困在lad中部。该并发症最终通过在骨折的导丝上放置支架得到解决,患者没有任何不良后遗症。讨论:本病例突出了冠状动脉介入治疗的罕见但潜在的严重并发症。建议的处理方法多种多样,从将断裂的金属丝留在原位并在其上放置支架,到采用不同的技术去除断裂的金属丝。然而,对于最佳策略,并没有达成共识。因此,作者对目前的文献进行了回顾,并提出了一种治疗这种罕见并发症的算法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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