Abandoned guidewire recapture from aortic root using “Guidewire twirling technique”

Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease, but it can be complicated by the loss and fracture of coronary guidewires within the vascular system, leading to severe complications such as vessel damage, occlusion, and embolization. This case report describes a unique and challenging scenario involving an 81-year-old male patient who, during an elective coronary angiography, was found to have a fractured and partially decoiled coronary guidewire extending from the aortic root to the left subclavian artery. The guidewire had likely been left in place during a previous procedure and was not documented in the patient's medical history. Given the potential for life-threatening complications, including occlusion of the left internal mammary artery graft, a percutaneous retrieval was attempted. Initial efforts using a snare system were unsuccessful. However, the guidewire was successfully retrieved using the “twirling guidewires” technique, which involved entangling the fractured wire with three 0.014-inch guidewires and carefully extracting it through a guide catheter. The patient avoided invasive surgery and was discharged without complications the day after. This case highlights the importance of recognizing and managing lost guidewire fragments using various percutaneous techniques, underscoring the need for interventional cardiologists to be adept in both coronary and peripheral retrieval strategies.