Coronary Guidewire Fracture Into a Radial Artery Loop: A New Complication in the Transradial Era?

J INVASIVE CARDIOL 2019;31(12):E398.

Key words: coronary guidewire fracture, radial artery loop, snare, wire fragment retrieval

An 82-year-old woman was scheduled for elective transradial coronary angiography (CA). Angiography of the forearm showed a radial artery loop (RAL) (Figure 1A). Despite advancement of a BMW Universal II coronary wire (CW) (Abbott Vascular) across the RAL, we were not able to advance a 6 Fr, JR 4 diagnostic catheter (Figure 1B). Next, we unsuccessfully attempted balloon-assisted tracking (Figure 1C). Thereafter, we observed the fracture of the CW into the RAL, and pulled back the proximal fragment while the distal one was located between the RAL and the right subclavian artery (Figures 1D-1F). Accordingly, after performing transfemoral CA and stent implantation, we advanced a 6 Fr, JR 4 guide catheter in the right subclavian artery and snared the distal part of the CW (Figures 1G and 1H).

RAL may hinder use of the radial route, but the advancement of a CW often allows the operator to overcome it. To date, complete fracture of a CW into an RAL has not been reported. We describe the occurrence of a new complication in the transradial intervention era.

From the Clinical and Interventional Cardiology Unit, Sassari University Hospital, Sassari, Italy.

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. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 4, 2019.

Address for correspondence: Giuseppe Talanas, MD, Clinical and Interventional Cardiology Unit, Sassari University Hospital, Via De Nicola 14, 07100 Sassari, Italy. Email: giuseppe.talanas@aousassari.it