Clinical and angiographic outcomes of patients undergoing entrapped guidewire retrieval in stent-jailed side branch using a balloon catheter.
OBJECTIVE
The purpose of this study was to examine the efficacy and safety of method for retrieval of entrapped guidewire in stent-jailed side branch using a balloon catheter.


BACKGROUND
Guidewire entrapment in the side branch after main vessel stenting is an infrequent but potentially serious complication of bifurcation lesion treatment. Entrapped wire retrieval with device advancement over the wire is a previously reported bail-out method, but its efficacy and impact on the proximal edge of the stent are unknown.


METHODS
We conducted a single-center, prospective study to evaluate the outcome of 28 consecutive patients who developed guidewire entrapment in a stent-jailed side branch after drug-eluting stent implantation, and underwent retrieval of entrapped wire using a balloon catheter. The primary objective was cumulative 12-month major adverse cardiac events including death, non-fatal myocardial infarction, target lesion revascularization, and stent thrombosis. Secondary objectives included binary restenosis and late lumen loss, evaluated in-stent, 5-mm proximal edge, and 5-mm distal edge sites at 9-month angiographic follow-up.


RESULTS
Entrapped guidewire retrieval was successfully achieved in all patients. Cumulative 12-month major adverse cardiac events were not observed in any patient. At angiographic follow-up, no significant differences were observed in late lumen loss between in-stent, 5-mm proximal edge, and 5-mm distal edge sites (0.12 ± 0.38 mm vs. 0.09 ± 0.27 mm vs. 0.03 ± 0.3 mm, P = 0.57). None of the patients had binary in-stent or in-segment restenosis.


CONCLUSIONS
Although the decision to apply the present method for entrapped guidewire retrieval should be made with careful consideration, it appears effective for bail-out. © 2013 Wiley Periodicals, Inc.
Department of Cardiovascular Medicine, Sakurakai Takahashi Hospital, Hyogo, Japan.
Shingo
S
Sakamoto
Norimasa
N
Taniguchi
Yukio
Y
Mizuguchi
Takeshi
T
Yamada
Shunsuke
S
Nakajima
Tetsuya
T
Hata
Akihiko
A
Takahashi
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization / Q000295:instrumentation; D062906:Cardiac Catheters; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D020878:Device Removal / Q000379:methods*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D018570:Risk Assessment; D016896:Treatment Outcome
complications; percutaneous coronary intervention; quantitative coronary angiography