Document Detail


Guide wire fracture during percutaneous transluminal coronary angioplasty: possible causes and management.
MedLine Citation:
PMID:  20351016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 46-year-old woman underwent diagnostic coronary angiography in our institution due to a myocardial ischemia following a dobutamine echo-stress test. The patient showed critical stenosis of the left anterior descending (LAD) artery involving the ostium of a large diagonal branch. The planned treatment of coronary bifurcation by percutaneous coronary intervention (PCI) was direct stenting of the main branch with 'jailed' wire technique to protect the side branch, provisional T stenting of the side branch, and final kissing balloon inflation. After successful stent implantation in the LAD, the 'jailed' wire fractured during withdrawal: the distal part of the fragment was trapped in the side branch, and the proximal one was knotted in the LAD, left main coronary and the aortic bulb. We decided not to retrieve the fragment by snare, and we planned heart surgery to safely retrieve the fragment and bypass the side branch not treated by percutaneous coronary interventions. Angiographic control nine months after surgery showed non in-stent restenosis; patient is alive and event-free at 18 months' clinical follow-up. In conclusion, percutaneous management of particularly complex bifurcational lesions may be associated with procedural risks; accordingly, it is important to consider and be ready for a rescue surgical revascularization.
Authors:
Manrico Balbi; Gian Paolo Bezante; Claudio Brunelli; Daniela Rollando
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-03-29
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-08-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  992-4     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Cardiology Unit, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  instrumentation*
Cardiac Surgical Procedures*
Coronary Angiography
Coronary Stenosis / radiography,  surgery,  therapy*
Device Removal*
Equipment Design
Equipment Failure
Female
Humans
Middle Aged
Stents
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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