Guidewire Entrapment Research Articles

Guidewire Entrapment During Percutaneous Intervention for Chronic Total Occlusion: A Rare Case Report

Iatrogenic complications occur in approximately 0.21% of percutaneous coronary interventions (PCI), which are critical for diagnosing and treating acute coronary syndrome. This case report details a rare complication involving guidewire entrapment during a PCI procedure for chronic total occlusion (CTO). A 71-year-old male with a diagnosis of myocardial infarction (MI) was admitted to the catheterization laboratory, where imaging revealed total occlusion of the Left Anterior Descending (LAD) artery. During the intervention, a balloon shaft breakage prevented the stent balloon from being withdrawn, necessitating an emergency surgical intervention. The guidewire was successfully removed, and urgent revascularization was performed through coronary artery bypass grafting (CABG). The patient experienced a stable recovery, being discharged after one week of intensive care unit monitoring and five days of ward observation. This case highlights the potential for severe complications in CTO interventions and suggests that pre-intervention consultation between cardiology and cardiovascular surgery teams could mitigate such risks and improve outcomes.

Injury of the superficial femoral artery and posterior tibial artery associated with an atherectomy device.

Rotational atherectomy can offer a viable treatment for occlusive peripheral artery disease; maintaining the minimal invasiveness of an endovascular procedure, while allowing for a more complete lesion debridement compared with balloon angioplasty. This case report outlines a complication of guidewire entrapment associated with rotational atherectomy in the superficial femoral artery (SFA). A 57-year-old male underwent an atherectomy with Rotorex for left lower limb foot pain. During the procedure, the guidewire was suctioned into the atherectomy device, preventing any further advancement of the device and damaging the SFA and posterior tibial artery (PTA). The atherectomy device was withdrawn and a new vascular access site was gained in the left PTA. A covered stent was inserted to treat the original SFA lesion, and balloon angioplasty was used to repair the device-induced damaged to the PTA. While guidewire complications have been previously reported, this case report details the first reported case, to our knowledge, of guidewire entrapment while using a rotational atherectomy device. Knowledge of this possible complication of rotational atherectomy can aid in clinical decision making when choosing between treatments for peripheral vascular disease.

Guidewire entrapment in the Chiari network during the insertion of a hemodialysis catheter: a case report

BackgroundThe Chiari network, a remnant of fetal anatomy, consists of a mesh-like structure within the right atrium. With advancements in cardiac interventions, complications associated with the Chiari network have increasingly been reported. However, there are few reports about guidewire or catheter entrapment in the Chiari network during the insertion of a dialysis catheter.Case presentationA 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network.ConclusionsThis case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

Technical aspects of entrapped coronary guidewire retrieval using rotational atherectomy device: A case series.

This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure. Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires. Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.

Management of Guidewire Entrapment and Fracture During Percutaneous Coronary Intervention: When All Bailout Techniques Fail!

A 55-year-old man presented with chest pain and was diagnosed with non-ST-segment elevation myocardial infarction. Coronary angiography revealed a 95% eccentric lesion in the mid-right coronary artery. After 3 intracoronary stents were placed, the guidewire became entrapped in 1 of the stents; multiple attempts at retrieval were unsuccessful. Ultimately, the guidewire fractured, and a coronary artery bypass graft surgery was performed to remove the guidewire fragments. This report reviews the procedural steps for wire retrieval that are critical for operators to avoid coronary artery bypass surgery.

Successful Extraction of Guidewire Entrapped in the Tricuspid Valve Leaflet Using a Laser Sheath

Right ventriculography is a necessary step for implantation of leadless pacemaker and is considered a safe procedure. However, an inappropriate manipulation of the guidewire can lead to serious complications. We present a case where the guide-wire was entrapped in the tricuspid valve, and its successful extraction using a laser sheath. (Level of Difficulty: Advanced.)

Nightmare of Coronary Wire Loop Jail from Side Branch to Main Vessel during Primary Percutaneous Coronary Interventions

Background: Guide wire breakage and entrapment inside the coronary circulation are rare but extremely dangerous complications of coronary intervention that can be life-threatening by resulting in embolization of thrombi, perforation of the coronary vasculature, and thrombus development.
 Case Presentation: A male patient who developed a complication of left circumflex artery guide wire looped and trapped under left anterior descending artery (LAD) stent during Primary PCI and went for emergency cardiac surgery for removal.
 Management & Results: Guide wire entrapment during the intervention should always consider this as a risk factor, especially when intervening in the tortuous coronary vasculature, and it is important to keep several wires, snare wires, and a surgical team on board as a backup.
 Conclusion: Although guide wire entanglement infrequently occurs during interventions, interventionists should always be on the lookout for it, especially in patients with convoluted coronary arteries. Before working on these patient's coronary arteries, it's essential to have a surgical team, lots of wires, and snare wires on hand. These preventative measures may be effective in reducing death and morbidity under adverse conditions.

Entrapment of Broken Guidewire in the Coronary Artery: A Rare Percutaneous Coronary Intervention Complication Requiring Urgent Revascularization

Entrapment of Broken Guidewire in the Coronary Artery: A Rare Percutaneous Coronary Intervention Complication Requiring Urgent Revascularization

LET THE HEART BE YOUR GUIDE: A TALE OF SURGICAL COMPLICATION AND MEDICAL MANAGEMENT

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Coronary guidewire entrapment and fragmentation during percutaneous coronary intervention is an infrequent complication with incidence between 0.1-0.2%. The retained fragment can lead to flow impediment, vessel thrombosis, distal embolism, and vessel perforation. Complications of guidewire retrieval include developing cardiac tamponade and requiring emergent cardiac surgery. We present a young male with severe multi-vessel disease and a rare procedural complication of coronary guidewire entrapment and fragmentation during percutaneous coronary intervention. CASE PRESENTATION: A 34-year old male with a past medical history for familial hyperlipidemia, hypertension, polysubstance abuse (opiate, benzodiazepine, tobacco, cocaine, alcohol, and marijuana), and hepatitis C presented with intermittent, substernal chest pain with radiation to the left arm. On presentation, patient was hypertensive, and his serum troponin-I peaked at 0.30 ng/mL. LDL was also markedly elevated at 234 mg/dL. His ECG revealed normal sinus rhythm with inferior Q-waves. Myocardial perfusion imaging revealed a medium area of moderate ischemia and infarction in the inferior wall with associated hypokinesis. He underwent coronary angiography which revealed an anomalous left circumflex originating from the right coronary cusp, diffuse right coronary artery disease, and a prior stent in the distal segment with a wire fragment entrapped between the previously deployed stent and the vessel wall. It was later found that this was a complication of his intervention 6 months prior where attempts to remove the wire percutaneously, as well as stenting the retained guidewire against the vessel wall, were all unsuccessful. Thus, the retained wire fragment was left at the stent site. Due to patient's young age and preference, a decision with cardiothoracic surgery was made for medical management to prevent morbidity associated with surgical correction. Patient was started on aggressive medical therapy, educated on substance abuse cessation, and scheduled for close follow-up. DISCUSSION: Risk factors for guidewire fragmentation and entrapment include extensive atherosclerosis of full-length coronary vessel, use of multiple guidewires, and tortuous lesions. Current therapeutic options for coronary guidewire entrapment include percutaneous management, surgical intervention, and conservative follow-up. The management of retained guidewires is not standardized. Percutaneous interventions for retrieval includes utilizing snares, filter wires, or forceps. Conservative management without intervention is indicated for retained guidewires located in small coronary branches with adequate post-occlusion blood flow. CONCLUSIONS: This case demonstrates tailoring therapy. Although, this complication is rare, medical management and lifestyle modification for retained guidewires represents an alternative option to percutaneous intervention. Reference #1: Al-Moghairi, A. and Al-Amri, H., 2013. Management of Retained Intervention Guide-wire: A Literature Review. Current Cardiology Reviews, 9(3), pp.260-266. Reference #2: Karabulut A, Daglar E, Cakmak M., Entrapment of hydrophilic coated coronary guidewire tips: which form of management is best? 2010. Cardiol J. 2010;17(1):104–108. Reference #3: Iturbe J., R. Abdel-karim A., Papayannis A., Mahmood, A., Rangan, B., Banerjee, S., Brilakis, E., 2023. Frequency, Treatment, and Consequences of Device Loss and Entrapment in Contemporary Percutaneous Coronary Interventions. Journal of Invasive Cardiology. 2012; 25(5): 215-221. DISCLOSURES: No relevant relationships by Christopher Bitetzakis, source=Web Response No relevant relationships by Arjun Khadilkar, source=Web Response No relevant relationships by Andrew Mehlman, source=Web Response No relevant relationships by Koushik Reddy, source=Web Response No relevant relationships by Christopher Schwartz, source=Web Response

Reply to in Response to Guidewire Entrapped in the Right Ventricle

How to cite this article: Verma A, Jaiswal S, Vishen A, Sheikh WR, Haldar M, Ahuja R, et al. Reply to in Response to Guidewire Entrapped in the Right Ventricle. Indian J Crit Care Med 2020;24(7):608.

In Response to Guidewire Entrapped in the Right Ventricle: A Rare Complication of Hemodialysis Catheter Insertion.

Verma et al. meticulously prevented the further complications once they recognize the entrapped guidewire in the right ventricle. Authors were very correct to mention overzealous insertion of the guidewire without watching the monitor, which may lead to such complications; however, every time monitor is not available for assistance. The Seldinger technique is routinely used for inserting central venous (CV) and hemodialysis (HD) catheters; however, both are different entities and their designs and lengths including of their guidewires vary. During guidewire insertions, simply adhering to the safe length may prevent or minimize many guidewire-related complications.How to cite this articleKumar R. In Response to Guidewire Entrapped in the Right Ventricle: A Rare Complication of Hemodialysis Catheter Insertion. Indian J Crit Care Med 2020;24(7):606–607.

Endovascular Removal of Entrapped Central Venous Catheter Guide Wire.

I present the case of a 24-year-old female patient with a guidewire entrapment during central venous catheter insertion. At first, open surgery was considered to remove the entrapped guidewire; however, after vascular surgery consult, it was removed by a simple endovascular procedure described below in detail.

Guidewire Entrapped in the Right Ventricle: A Rare Complication of Hemodialysis Catheter Insertion.

How to cite this article: Verma A, Chitransh V, Jaiswal S, Vishen A, Sheikh WR, Haldar M, et al. Guidewire Entrapped in the Right Ventricle: A Rare Complication of Hemodialysis Catheter Insertion. Indian J Crit Care Med 2020;24(1):80–81.

Fractured Guidewire Entrapped in the Ostium of Right Coronary Artery Mimicking Aortic Flap

An 84-year-old male patient with ischemic heart disease was referred to transesophageal echocardiography evaluation of mitral regurgitation. He previously underwent multiple percutaneous coronary interventions (PCI) in another hospital, the last intervention 3 years ago. Flail anterior leaflet of

TCTAP C-144 Coronary Rupture During Treatment for Guidewire Entrapment Between Calcification and Stent in the PCI for LAD#7 CTO

TCTAP C-144 Coronary Rupture During Treatment for Guidewire Entrapment Between Calcification and Stent in the PCI for LAD#7 CTO

TCTAP C-118 Unexpected Entrapment of Guidewire by Bioresorbable Vascular Scaffold Deployment at Calcified Coronary Lesion

### Patient initials or identifier number 5256900 ### Relevant clinical history and physical exam This 64-year-old man experienced intermittent chest tightness during exercise for one year. Thes ymptoms get worse gradually, and the duration prolonged from few minutes to near half hour, and

Entrapment of guidewire in left anterior descending artery: Surgical management

Entrapment of a guidewire during coronary artery interventions is rare and requires prompt treatment. A 52-year-old man underwent a primary percutaneous transluminal coronary angioplasty to the left anterior descending artery. A fractured guidewire was retained in the distal left anterior descending artery, which caused left ventricular dysfunction and total occlusion of the left anterior descending artery. He underwent endarterectomy with removal of the guidewire and bypass grafting. He had a normal postoperative period. The modalities for management of an entrapped guidewire are discussed.

Successful non-surgical management of entrapped hydrophilic guidewire during percutaneous coronary intervention

Guidewire breaking or entrapment during the procedure is a rare but well-reported complication of percutaneous coronary intervention. The entrapped guidewire can be managed through intervention, surgery or conservatively depending upon the clinical situation and position of the guidewire. However, the entrapped guidewire leads to serious complications such as thrombosis, occlusion of the coronary vessel or systemic embolism. As far as the authors’ knowledge is concerned, there is no guideline available for optimal management of entrapped guidewire even though such cases have been reported since the beginning of percutaneous intervention era. Here the authors present a case of hydrophilic guidewire entrapment where a different technique for removal was used.

Entrapped coronary angioplasty guidewire and its retrieval from aorta and LAD

A rare but serious complication of coronary interventions is entrapment of coronary angioplasty guidewire. A failed percutaneous transluminal coronary angioplasty (PTCA) attempt to the left anterior descending (LAD) was complicated by entrapment of the guidewire in the LAD and aorta. Under cardiopulmonary bypass and cardioplegic arrest, the whole length of entrapped guidewire was retrieved successfully from the LAD and aorta through aortotomy following revascularization of the LAD with the left internal mammary artery (LIMA).