title: Consequences and treatment of guidewire entrapment and fracture during percutaneous coronary intervention.
abstract: Guidewire fracture is an uncommon, yet feared complication of percutaneous coronary intervention that may be more likely to occur in complex lesions and when guidewires interact with newly deployed or pre-existing stents. Wire fragments can often be retrieved using percutaneous techniques, but may need to be removed surgically in case of percutaneous retrieval failure. We present two cases of guidewire entrapment and fracture. In the first case the fractured polymer-jacketed guidewire was successfully retrieved, after crossing the lesion with another guidewire and performing balloon dilation next to the entrapped guidewire. In the second case, attempts for percutaneous guidewire retrieval failed. The wire fragment protruded into the ascending aorta leading to emergent cardiac surgery. We also reviewed the published literature on guidewire fracture and entrapment since 2007, providing an update on risk factors, consequences, and managements of this complication.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D020878:Device Removal / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D015607:Stents; D016896:Treatment Outcome
keywords: Chronic total occlusion; Complications; Guidewires; Percutaneous coronary intervention