An Accidentally Trapped Wire
Dr. Sze-wah LAI
Kwong Wah Hospital, Hong Kong
A 73 year-old gentleman, with history of hypertension and calcified brain cavernoma, complained of exertional chest pain. Exercise treadmill test was positive. Echocardiogram showed a normal LV ejection fraction with trivial mitral regurgitation. He underwent a coronary angiogram which showed severe distal LM, proximal LAD, diffuse D2 and ramus diseases (Movie 1,Movie 2). The LCx was tortuous and small. The distal RCA and PL branch also had severe disease. PCI was performed to the RCA and PL branch and the patient was brought back again for staged PCI to the left system.
The lesions were first prepared with kissing balloon inflation to LAD & D2. D2 and ramus branch were then treated with 2 DEBs (Figure 1,Figure 2). A 3.5x38mm DES was implanted from ostial LM to mid-LAD (Figure 3). The LCx wire was noticed to be prolapsed and trapped in the LAD after stent deployment (Figure 4). The LCx wire was attempted to be retrieved by using 2 anchoring balloons, one at the guiding catheter and the other one at the mid-LAD, but the wire was broken while it was being pulled out (Movie 3). The LM stent was further post-dilated to ensure proper stent apposition after excessive pulling of the LCx wire. IVUS showed the broken wire was trapped outside the LM stent and part of it was hanging out in the guiding catheter. Another 7-French guiding catheter was used to engage the LM and another guidewire was wired down into the LAD. IVUS showed the new guidewire was not under struts. A 3.0mm NC balloon was inflated at the tip of the original 8-French guiding catheter, trapping the broken guidewire, and then the whole system was pulled out (Movie 4). The stent was found to be damaged and broken apart in the middle of LAD (Figure 5). Another DES was deployed to cover the gap. The final angiogram showed satisfactory final result (Movie 5).
