A case of fractured guide wire perforating the coronary artery and ascending aorta during percutaneous coronary intervention

Abstract

We experienced a rare and serious case of fractured hydrophilic guide wire necessitating surgical intervention during percutaneous coronary intervention (PCI) for a tortuous and calcified stenosis in the proximal right coronary artery. An 85-year-old female presented to our hospital and was diagnosed as having unstable angina. A 0.014in. hydrophilic guide wire (HI-TORQUE WHISPER MS Guide Wire™, Abbott Vascular, Abbott Park, IL, USA) was fractured during PCI trying to pass a microcatheter Corsair™ (ASAHI INTEC, Seto, Japan). During the procedure to retrieve the retained guide wire, the distal segment of the fractured guide wire penetrated the atherosclerotic coronary wall and ascending aorta unexpectedly. The surgical procedure could be performed successfully by extracting the fractured guide wire segments and stopping the bleeding. The edge of a hydrophilic guide wire that is fractured by friction between the microcatheter and guide wire is extremely sharp and can perforate both the atherosclerotic coronary vessel wall and aortic wall. Caution should be exercised when using such a device in combination with a polymer-jacketed wire at an acute angulated and calcified lesion.<Learning objective: Guide wires are the most common devices for interventional cardiologists. Guide wire fracture is a rare complication, but cardiologists should be well informed about it. This case report presents a detailed situation of hydrophilic guide wire fracture and penetration of coronary artery and even the aorta and discusses the mechanism.>