CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 162 AFRICA Successful retrieval of an entrapped and uncoiled guide wire using a wire-cutting technique Wenjie Tian, Linxian Cui, Christopher J Nicholson, Rajeev Malhotra Abstract Entrapment and uncoiling of a guide wire are life-threatening and technically challenging complications during percutaneous coronary intervention. We present a case using a wirecutting technique with the guidance of intravascular ultrasound (IVUS) to retrieve an entrapped and uncoiled guide wire under the stent struts in a calcified circumflex artery. Keywords: percutaneous coronary intervention, complication, intravascular ultrasound Submitted 12/7/20, accepted 6/11/21 Published online 8/3/22 Cardiovasc J Afr 2022; 33: 162–164 www.cvja.co.za DOI: 10.5830/CVJA-2021-056 During percutaneous coronary intervention (PCI), fracture and uncoiling occasionally occur while attempting to withdraw an entrapped guide wire.1-3 The fractured guide wire may continue to uncoil and float into the peripheral arteries, cerebral arteries or aorta, resulting in high risk of thrombus formation and the potential for severe clinical sequelae.4,5 Hence, fracture and uncoiling of the guide wire is regarded as a severe and lifethreatening complication, requiring proper management without delay. Percutaneous retrieval approaches include guide wire intertwining, snare capture and balloon inflation withdrawal.2,3,6 In some situations, surgical removal will be indicated if percutaneous retrieval is unsuccessful.7 Herein, we present an intravascular ultrasound (IVUS)-guided wire-cutting technique to withdraw an entrapped and uncoiled guide wire. Case report A 61-year-old man with a history of hypertension and hyperlipidaemia was admitted for three years of intermittent and one week of crescendo chest pain. Electrocardiogram demonstrated ST-segment depression in the anterior and inferior leads. Coronary angiography revealed subtotal occlusion in the middle segment of the left anterior descending (LAD) artery, 85% stenosis in a tortuous, calcified left circumflex artery (LCX) and 80% stenosis in proximal right coronary artery (Fig. 1A–C). The patient declined evaluation for coronary artery bypass grafting and preferred percutaneous coronary intervention (PCI) treatment. Via right radial access, a stent (2.75 × 38 mm, Xience Prime, Abbott, USA) was deployed in the mid-LAD (Fig. 1D). Subsequently, a Sion guide wire (Asahi, Nagoya, Japan) and a BMW guide wire (Abbott, USA) were respectively placed into the LCX and the obtuse marginal (OM) artery. After pre-dilation with a 2.5 × 15-mm balloon (Sprinter, Medtronic, USA), two stents (2.75 × 23 mm, 3.0 × 28 mm, Xience Prime, Abbott, USA) were deployed from the distal to the proximal LCX, followed by post-dilation with a 3.0 × 15-mm non-compliant balloon at 18–22 atm. The BMW guide wire was not retrieved from the OM prior to post dilation, resulting in the entrapment of the guide wire under the stent struts. The operator attempted to pull the guide wire out from the OM, but the BMW guide wire was uncoiled and fractured. The fractured portion of the guide wire was removed leaving part of the metal inner core and the entire outer coil in the body. (Fig. 1E). The radial sheath was removed and the patient was sent back to the ward. Interestingly, the guide wire was protruding from the punctured site of the radial artery the next day due to the continuous uncoiling of the guide wire (Fig. 1F). The operator failed to pull out the guide wire because the protruded portion was connected to the entrapped portion and the two portions remained as a whole segment in vivo. Subsequently, the patient was transferred to the catheterisation laboratory for retrieval of the guide wire. A 7.0-Fr EBU3.75 guiding catheter was engaged via right femoral artery access. IVUS revealed that the residual guide wire was floating in the left main and proximal LCX (Fig. 2A). Given the challenge of removing the entrapped portion of the guide wire, we decided to cut off the guide wire at the ostium of the LCX. Via the puncture site, the guide wire was pulled until the uncoiling process terminated. A 0.009-inch RotaWire was placed into the LAD and rotational atherectomy was performed using a Rotablator (burr size, 1.5 mm; Boston Scientific, USA) at 140 000 rpm while firmly grasping the guide wire (Fig. 2B). After a 10-second rotablation, the guide wire was successfully cut off and retrieved (Fig. 2C). IVUS revealed that the guide wire was cut off at the ostium of the LCX and no guide wire was in the left main coronary artery (Fig. 2D, E). Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China Wenjie Tian, MD, PhD, tianwenjie1976@hotmail.com Linxian Cui, MD Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA Christopher J Nicholson, MD, PhD Rajeev Malhotra, MD, MS Harvard Medical School, Boston, MA, USA Rajeev Malhotra, MD, MS
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