Case 33: Manual of non-CTO coronary interventions: guidewire fracture and unraveling

A patient underwent left main stenting into the LAD jailing the circumflex guidewire. During retrieval of the circumflex guidewire the tip tied a knot on the left main stent. During attempts to retrieve it, the guidewire fractured. Use of various snares resulted in unraveling of the guidewire distal coil into the aorta. The patient went to emergent surgery that revealed a "mesh" of guidewire coil in the ascending aorta.
In case of guidewire entrapment one should not pull hard as this may lead to fracture. Advancing a balloon or microcatheter can help free the guidewire without fracture. If guidewire fracture occurs it is important to determine if unraveling has occurred: if the guidewire has unraveled into the aorta, emergent surgery is required for removal of the unraveled guidewire, otherwise thromboembolic complications may occur.

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