CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 163 Post-dilation was performed with non-compliant balloons (3.5 × 12 mm, 4.0 × 8 mm) at 18–20 atm. The patient was discharged three days later and received dual antiplatelet therapy with aspirin 100 mg and ticagrelor 180 mg daily. After one year, the patient underwent follow-up angiography, which showed no restenosis or thrombus formation at the site of the residual entrapped guide wire (Fig. 2F). Based on the results from the follow-up angiography, ticagrelor was stopped and aspirin was recommended for long-term use. Up to the present time, the patient has been seen at two-year follow ups and remains in good condition without any chest pain. Discussion Although the uncoiling and entrapment of a guide wire is a rare occurrence, the outcomes of this complication may be catastrophic due to the risk of thrombus formation in the coronary artery.4 Optimal management of this complication remains under debate and removal of the guide wire is technically challenging.6,8 In a series of case reports, snare capture or balloon inflation withdrawal is the most common technique used for the removal of the guide wire.2,3 However, these techniques were unsuitable in this case because any forced withdrawal would have unavoidably resulted in recurrence of fracture and floating of the uncoiled guide wire. Hence, our strategy was to pull the guide wire until the uncoiling process terminated and use rotational atherectomy to cut off the guide wire at the ostium of the LCX so that no guide wire remained in the left main artery. This wire-cutting technique presents an important alternative in cases where conventional retrieval techniques are not feasible and provides an applicable approach to avoid surgical retrieval. A key consideration of this wire-cutting technique is to keep the guide wire straight while performing rotational atherectomy. A curved guide wire may entwine the burr and cause it to be entrapped. Additional lessons derived from this case were: (1) due to the risk of uncoiling, a BMW guide wire is not recommended to be used as a protective guide wire in the branch vessel of the coronary artery; (2) great care should be taken to avoid guide wire fracture after uncoiling as the residual guide wire would continue to uncoil and float into the other arteries; (3) as an important tool, IVUS provided vital information to optimise the procedure; (4) with standard antiplatelet therapy, the remaining guide wire in the coronary artery may be safely retained with thrombus-free status. Conclusion The retrieval of an entrapped and uncoiled guide wire is extremely challenging. In cases where conventional retrieval techniques are not feasible, a cutting-wire technique using rotational atherectomy is a potential alternative to avoid surgical retrieval. Fig. 1. Entrapment and uncoiling of a BMW guide wire in the left circumflex coronary artery. (A) Subtotal occlusion in the middle segment of the LAD. (B) There was an 85% stenosis in the tortuous, calcified LCX. (C) There was an 80% stenosis in the proximal right coronary artery. (D) A 3.0 × 33-mm stent was implanted in the LAD. (E) The BMW guide wire was entrapped and uncoiled in the LCX. (F) The uncoiled guide wire was extruded from the puncture site of the right radial artery. A D B E C F
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