Complication an Management of Percutaneous

Coronary Interventions
 Background
Nonsurgical technique for treating obstructive
PCI coronary artery disease, including unstable
Percutaneous Coronary angina, acute myocardial infarction (MI), and
Intervention multivessel coronary artery disease (CAD).

Entrapment and fracture of coronary guide-wire  rare

complication 0,1-0,2%

Thrombosis, embolic phenomena,

dissection, perforation, and vessel
occlusion.
 Management of Guide-wire Fracture

Percutaneous Retrieval

Surgical Removal

Leaving the corpus alienum in-situ

Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013
Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013
 Catheter Based Retrieval

Retrieval  with two or more wires passed

alongside the entrapped wire, and the torque is
then applied to all wires and a twisting action
results in wires wrapping around the retained
wire and trapping it between the wrapped
portions.

Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013
 Surgical Extraction
Percutaneous techniques fail  surgery can
combined with bypass grafting.
Bypass surgery is performed in most of the
cases.
Surgical extraction  direct coronary
arteriotomy or aortotomy, left main (LM)
coronary arteriotomy and patch repair

Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013
 Medical Management
Remove retained guide-wire remnants 
preferable option.
Some case reports and case series  a reasonable
option might be to leave the guide-wires in-situ if
there is a chance of success seems remote based
on the anatomic and technical considerations
Treatment  systemic anticoagulation and anti-
platelets agent with close follow up

Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013
 A. Baseline coronary angiogram showing two focal lesions in right coronary artery;
B. After treatment;
C. Broken guide wire fragment is retained in distal part of right coronary artery;
D. Broken wire fragment is seen during left side coronary angiogram;
E, F. At two year follow-up, angiogram shows that the broken guide wire is still in the
same position, with no restenosis

Sahin KaplanSafiye Tuba Kaplan, Merih Kutlu, An unusual case of guide wire fractured during primary percutaneous coronary intervention,
and two year follow−up, Kardiologia Polska, 2010.
 Complications of Guide Wire Retrieval
Prolonged manipulation  increase the risk of
thrombus or air embolization.
Failure of removal of retained fragments 
myocardial ischemia due to coronary thrombosis
or obstruction.
Vessel dissections or rupture from repeated
instrumentation  tamponade or emergency
cardiac surgery with associated high mortality

Abdulrahman M. Al-Moghairi* and Hussein S. Al-Amri, Management of Retained Intervention Guide-wire: A Literature Review, Current
Cardiology Reviews, 2013