IJCS | Volume 33, Nº4, July and August 2020

420 Figure 1 - A) Lesions of the LAD and diagonal arteries (arrows); B) The stuck guidewire in the diagonal coronary artery (arrow). by arteriotomy of the diagonal artery. Then aortotomy was performed and the 12 cm piece of guidewire was successfully retrieved (Figure 2). Then an aorta-LAD artery to the LIMA graft bypass and an aorta-diagonal artery to the SVG bypass were performed. There were no complications in the postoperative period and the patient was discharged after four days. Discussion Complex and bifurcation lesions of the coronary arteries, multiple usages of the same guidewire lead to structural deterioration of the wire, which increases the risk of guidewire entrapment in the coronary vessel. 3 Over-rotation or entrapment of the distal tip of the guidewire in a coronary vessel can also lead to the wire fracture. 3 The guidewire fragments retained in the coronary artery can cause arterial embolism, thrombosis, dissection, and rupture of the vessels. 3 Treatment options of entrapped guidewire are percutaneous intervention techniques, conservative therapies, and open surgery. 1,4 Percutaneous intervention techniques are recommended as the treatment of choice. The most commonly used percutaneous technique in this complication is the snare loop and its modifications. Small pieces of guidewire can remain in the distal segments of the coronary arteries or in chronically occluded or thrombosed vessels if they do not cause any adverse effects. If percutaneous techniques fail and signs of ischemia are observed, then the patient should be urgently transferred to open surgery. 3 Surgical treatment consists of removal of the retained piece of guidewire and revascularization of the affected coronary arteries. 5 In the present case, guidewire entrapment was probably caused use of a reused guidewire, which was entrapped in a calcified coronary plaque and broke in the femoral region after forceful attempts to remove it. The distal part of the guidewire extended to the ascending aorta from the diagonal artery. Urgent surgery was preferred in this case after failure of percutaneous intervention techniques and because the conventional method was not applicable. Conclusion The number of studies about surgical removal of fractured guidewire entrapped in a coronary artery is Coskun et al. İntracoronary broken guidewire Int J Cardiovasc Sci. 2020; 33(4):419-422 Case Report