Coronary Intervention Complicated by Pressure Wires Caught Within Stent Struts

J INVASIVE CARDIOL 2017;29(9):E102-E103.

Key words: PCI, pressure wire, complication management

Coronary guidewire fracture or entrapment is a recognized complication of percutaneous coronary intervention that can result in abrupt vessel closure, thrombosis, or stent deformation. Developments in pressure-wire (PW) design have enabled their use for coronary intervention. We describe two cases where the pressure sensor became trapped against stent struts during PW removal. In the first case, this resulted in retrieval of stent on removing the PW. In the second case, distortion of stent structure made it impossible to remove the PW; therefore, we had to snap the PW. We report the first cases to our knowledge of PW entrapment within stent struts. It is important that interventional cardiologists be aware of the potential occurrence of this complication, which may be related to contemporary wire design.

Patient #1. A 67-year-old male presented with non-ST segment elevation myocardial infarction (NSTEMI). Coronary angiography demonstrated stenoses in the left circumflex (LCX) and diagonal arteries (Figures 1A, 1B). Intervention to the ostial LCX was performed with a Xience Pro 3.0 x 28 mm (Abbott Vascular) (Figures 1C, 1D) and subsequent Verrata PW (Volcano Corporation) assessment of the first diagonal was performed. While pulling back the PW, resistance was noted that was overcome by progressive traction, resulting in retrieval of both the wire and LCX stent, which was attached to the wire at the pressure sensor (Figure 1E) likely due to inadvertent advancement of the PW through protruding ostial LCX stent struts. A new Xience Pro 3.0 x 28 mm stent was implanted in the LCX (Figure 1F) without further complications.

Patient #2. A 54-year-old male presented with NSTEMI. Coronary angiography demonstrated disease in the left anterior descending (LAD) coronary artery (Figure 2A) and mid-LCX. He underwent PW assessment of the LCX (negative) and LAD (positive). Intervention was undertaken to the LAD using the PW as the interventional wire that did not move throughout the procedure, with implantation of 3 x 12 mm, 3 x 8 mm, 2.5 x 26 mm, and 2.25 x 12 mm Resolute Onyx (Medtronic) stents (Figure 2B). Resistance was noted on withdrawing the PW. Traction resulted in distortion and shortening of the mid-vessel stent (Figure 2C). It was not possible to rewire the vessel and further retraction of the wire resulted in fracture of the PW at the pressure transducer (Figure 2D). This was managed by the further implantation of a 3.5 x 30 mm Resolute Onyx stent (Figure 2E) without complication.

A recent literature review revealed 67 cases of guidewire entrapment or retained fragments.¹ We report two cases of PW entrapment that may be related to wire design, with both instances occurring at the level of the pressure transducer. We postulate that increased wire diameter or an uneven surface at this level (Figure 2F) was the cause.

Reference

1.    Al-Moghairi AM, Al-Amri HS. Management of retained intervention guide-wire: a literature review. Curr Cardiol Rev. 2013;9:260-266.

From the Cardiology Department, Imperial College Healthcare NHS Trust, London, United Kingdom.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted March 29, 2017.

Address for correspondence: Dr Ozan M. Demir, Interventional Cardiology Fellow, Specialist Registrar in Cardiology, Hammersmith Hospital London, London, United Kingdom. Email: ozan.demir@nhs.net