Traveling Wire After Chronic Total Occlusion Percutaneous Coronary Intervention

A 72-year-old patient underwent percutaneous coronary intervention (PCI) of a right coronary artery (RCA) chronic total occlusion (CTO) (Figure 1A). During the femoral puncture, a plastic guidewire could not advance, so it was removed. A second fluoroscopy-guided puncture was performed, visualizing a broken piece of the wire apparently at the femoral artery (Figure 1B). PCI was continued because a subintimal position was suspected. After intravascular lithotripsy and stenting of the proximal right coronary artery (RCA) (Figure 1C) using a dual-lumen microcatheter (Figure 1D), PCI was successfully completed (Figure 1E; Video 1). A final angiography of the femoral artery confirmed that it remained in the same position, so it was left there (Figure 1F; Video 2).

Ten days later, the patient underwent a new coronary angiography for chest pain. A radiopaque linear element at the right lung was observed (Figure 2A). The broken wire was not in the previous femoral position (Figure 2B), and we deduced that it was initially in the femoral vein and migrated to the pulmonary artery. After discarding any coronary complication, we advanced a guiding catheter to the right pulmonary artery, performed an angiography (Figure 2C; Video 3), and snared the broken wire, resulting in successful retrieval (Figure 2D-2E; Video 4). Guidewire-related complications are rarely reported, but are associated with significant mortality and morbidity. Although the radial approach is preferred in the majority of cases, the femoral approach is needed in some complex procedures. Ultrasound guidance decreases complications. Additionally, the use of plastic wires with metallic needles can produce wire rupture.

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