IJCS | Volume 33, Nº4, July and August 2020

DOI: 10.5935/2359-4802.20190086 Introduction Entrapment and fracture of the coronary guidewire is a rare complication of percutaneous coronary interventions (PCIs). The incidence of such complication in PCI is reported to be between 0.2 and 0.8%. 1,2 Despite technical improvements and development of more flexible and high-quality guidewires, the incidence of these complications is increasing. 3 There are many management strategies for entrapped guidewires reported in the literature. In a report including 67 patients, surgery was performed in 43.4%, percutaneous interventions were performed in 41.8% and conservative therapies were chosen for 14.9% of the patients. 4 Herein, we reported a case of broken and entrapped guidewire in a coronary vessel during PCI which was removed by open heart surgery. Case report A 53-year old male patient was referred to our center with the diagnosis of non-ST elevated myocardial infarction (NSTEMI). He had a history of chest pain which lasted for approximately six hours. He had chronic coronary artery disease and had been using acetylsalicylic acid (ASA) and metoprolol for seven years. He also had a history of PCI performed in another health center two years before. Coronary angiography and PCI were planned for the patient after primary evaluation in the emergency room. Laboratory results showed a troponin T level of 0.166 ng/mL, total cholesterol of 213 mg/dL and low-density lipoprotein (LDL) of 150 mg/dL. There was no sign of myocardial ischemia in the electrocardiogram (ECG). The left ventricular ejection fraction (LVEF) was 60% and concentric left ventricle hypertrophy was observed by echocardiograph. A diagnostic coronary angiography revealed a plaque in the middle segment of the left anterior descending (LAD) artery, and PCI was then performed. A 182 cm x 0.014” floppy guidewire was introduced into the LAD artery and another guidewire of the same size was introduced into the diagonal artery for prevention of the diagonal artery occlusion through the right femoral arterial access sheath. A coronary stent (Coroflex® ISAR NEO 3.0 mm X 16 mm, B. BRAUN, Germany) was implanted into the lesion in the middle segment of the LAD artery at 16 atm pressure. Unfortunately, the distal piece of the guidewire in the diagonal artery broke and was entrapped in the coronary artery (Figure 1).Although the remaining piece of the guidewire was easily removed, the piece entrapped in the coronary artery could not be removed with the loop snare or an angioplasty balloon (3.5 x 15 mm, NC Boston Scientific). After failure of these measures, an urgent coronary bypass operation was planned. The patient had no chest pain or arrhythmias during or after the PCI procedure. After preparation for the coronary artery bypass graft surgery (CABG), the patient was transferred to the operating room. Cardiopulmonary bypass was initiated after standard median sternotomy and cavoatrial cannulation. The left internal mammary artery (LIMA) graft and the saphenous vein graft (SVG) were harvested. The coronary arteries were exposed. The retained piece of guidewire in the coronary artery could not be removed 419 CASE REPORT International Journal of Cardiovascular Sciences. 2020; 33(4):419-422 Mailing Address: Elif Coskun Bulent Ecevit University Faculty of Medicine - Eski Kozlu Yolu, Postal Code: 67000, Zonguldak - Turkey E-mail: drelfco@gmail.com Entrapment of Broken Guidewire in the Coronary Artery: A Rare Percutaneous Coronary Intervention Complication Requiring Urgent Revascularization Elif Cosku n, Levent Altına y, A nıl Teki n, Ufuk Tutu n Bulent Ecevit University Training and Research Hospital, Kozlu, Zonguldak - Turkey Manuscript received on September 20, 2018; reviewed on June 05,2019; accepted on July 08,2019. Coronary Artery Disease; Myocardial Infarction; Angiography, Coronary; Percutaneous Coronary Intervention/complications, Device Removal; Myocardial Revascularization. Keywords