Fractured Wire in the Left Internal Mammary Artery: A Novel Retrieval Technique

J INVASIVE CARDIOL 2017;29(3):E39-E40.

Key words: coronary angiography, angioplasty, graft intervention, new techniques

An 84-year-old man had a history of two prior coronary artery bypass graft operations, multiple percutaneous coronary interventions, and left ventricular systolic dysfunction. He presented with recurrent angina, Canadian Cardiovascular Society angina class III. Coronary angiography revealed severe three-vessel coronary disease and bypass graft angiography revealed a totally occluded stent in the proximal left internal mammary artery (LIMA) (Figure 1). As such, percutaneous LIMA intervention was planned. A 180 cm Kinetix wire (Boston Scientific) was advanced into the occluded LIMA via a 6 Fr LIMA guide catheter. The tip of the wire became entrapped in the stented segment of the occluded vessel. Further manipulation resulted in wire fracture. The body of the wire was removed while approximately 20 centimeters of the soft tip remained in the patient, with half in the LIMA and the other half free in the left subclavian artery (Figure 2). Traditional retrieval techniques were unsuccessful. A novel retrieval technique was attempted. A Balance Middleweight universal coronary wire (Abbott Vascular) was advanced anterior and distal to the fractured wire. The guide catheter was torqued posteriorly, and an Amplatz GooseNeck Microsnare (Covidien) was advanced into the mid subclavian artery also distal to the fractured wire. The shaft of the Balance Middleweight wire, rather than the soft tip, was snared distal to the fractured wire. As the Microsnare and snared Balance Middleweight wire were pulled back, the Kinetix wire that had been positioned between the two devices was securely trapped and successfully removed from the patient (Video 1).  Although fractured coronary wires are a rare occurrence, failures to retrieve them successfully put patients at undue risk.¹ This technique can be used when traditional retrieval with a Microsnare system is unsuccessful.

References

1.     Chang T, Pellegrini D, Ostrovsky A, Marrangoni A. Surgical management of entrapped percutaneous transluminal coronary angioplasty hardware. Tex Heart Inst J. 2002;29:329-332

From the Cardiovascular Division and Elaine and Sydney Sussman Cardiac Catheterization Laboratories, University of Miami Hospital, Miller School of Medicine, Miami, Florida.

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.

Manuscript submitted August 29, 2016, provisional acceptance given August 31, 2016,  final version accepted September 21, 2016. 

Address for correspondence: Eduardo J. de Marchena, MD, Professor of Medicine and Surgery, Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, 1400 N.W. 12th Avenue, Suite 1179, Miami, FL 33136. Email: emarchen@med.miami.edu