Korean Circ J.  2013 Nov;43(11):761-765. 10.4070/kcj.2013.43.11.761.

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

• Kim TJ
• Kim JK
• Park BM
• Song PS
• Kim DK
• Kim KH
• Seol SH
• Kim DI

• KMID: 2224808
• DOI: http://doi.org/10.4070/kcj.2013.43.11.761

Abstract

During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.

Keyword

Percutaneous; Stents; Thrombosis; Complications

MeSH Terms

Coronary Thrombosis
Coronary Vessels*
Methods
Percutaneous Coronary Intervention
Prognosis
Stents*
Thrombosis*

Figure

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  Fig. 1 Left coronary angiogram showed tight and significant stenosis at the bifurcation site of LM. A: right anterior oblique caudal view. B: left anterior caudal view. LM: left main coronary artery.

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  Fig. 2 Guidewire fracture and mechanical removal of the remmants. A: during PCI runthrough, guidewire was broken at the junction of hydrophilic coated part and non-hydrophilic one (thick arrow). B: attempts to retrieve the elongated guidewire filaments in the ascending aorta (narrow arrows) by using a snare device were not successful. C: some parts of the filaments were removed by endoscopic biopsy forceps (arrowhead). PCI: percutaneous coronary intervention.

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  Fig. 3 Un-coiled filaments of the runthrough guidewire with biopsy forceps (A and B).

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  Fig. 4 Cine and IVUS images after mechanical extraction of the fractured guidewire. A: the radiopaque tip of runthrough guidewire was evident within the LCX and its small branch. B: long and thin guidewire filaments were not seen in cine view. C: IVUS showed guidewire filaments (arrows) remaining from the proximal LCX to distal LM. PCI: percutaneous coronary intervention, LCX: left circumflex artery, LM: left main coronary artery, IVUS: intravascular ultrasound.

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  Fig. 5 CAG showed LM total occlusion with remnant guidewire. LM: left main coronary artery, CAG: coronary angiogram.

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