Surgical retrieval of entrapped coronary guidewire remnant – 3-year angiographic evaluation

Percutaneous interventions, despite constant improvement of hardware and techniques, are not free of complications. Although problems with delivery systems occur rarely, knowledge how to manage them is an obligatory component of an interventional cardiologist’s training and practice.
Breakage of the intravascular equipment is estimated to occur in 0.1–0.2% of all procedures [1, 2]. If such complications occur, there are three possible options: percutaneous removal (when possible), a surgical procedure (removal/removal with coronary artery bypass grafting/sole coronary artery bypass grafting) or leaving the fragment intact inside the vessel.
There are numerous cases described in the literature. However, it is difficult to find two similar clinical descriptions and therapeutic algorithms. In consequence, there are no clear procedural guidelines. It is also uncommon to obtain long-term follow-up in those patients.
Although percutaneous removal seems to be the most desired treatment, it is always dependent on the operator’s experience, as the risk of vascular trauma, coronary spasms or new fragmentation must be taken into consideration. Since the material in separate cardiology departments is not extensive enough for a decisive study, the knowledge must be built upon a series of case reports. It would be perfect for the clinician to review the literature with long-term follow-up as well, especially in controversial cases.
The presented letter to the editor contains a long-term follow-up to a case reported previously [3]. The patient is a 67-year-old male patient with unstable angina, who underwent an unsuccessful angioplasty procedure over three years ago, which was followed by surgical removal of a broken guidewire and coronary artery bypass grafting. In this case, coronarography findings were quite interesting.
The patient’s history includes several cardiovascular incidents and interventions. At the age of 55, he was referred to the invasive cardiology department with unstable angina. He underwent angioplasty of the anterior interventricular branch of the left coronary artery (left anterior descending – LAD) with implantation of a bare metal stent (BMS). Due to the recurrence of the symptoms related to restenosis, repeat LAD angioplasty was performed at the age of 62 – this time with the use of drug-eluting stent. This time the angiography revealed significant stenosis in the right coronary artery (RCA) and circumflex artery...


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