Case 88: PCI Manual - Wire entrapment and fracture

A patient was referred for circumflex PCI. A wire was initially placed in the LAD and upon withdrawal it became entrapped in the left main. Attempts were made to free it up by advancing several balloons and microcatheters all the way to the point of entrapment without success. A second guide catheter was inserted and balloon angioplasty and laser atherectomy were done next to the entrapped wire, again without success. Eventually the wire broke, but the fragment remained entirely within the left main and did not unravel as confirmed by IVUS. The wire fragment was covered with stents and both IVUS and OCT confirmed no protrusion into the aorta.

[@matheuscsmed]

Thank you, Matheus Silva

[@MinorityDoc]

Thanks for posting

[@mohamedkishkt3667]

thanks for informative approach

[@shangz0216]

Thanks for sharing！

[@durgaprasad-nv2cd]

Good case and very well managed
Thank you sir

[@llacielona]

thank you for sharing! I still don`t get it how the wire got trapped?

[@manosbrilakis]

The wire prolasped into the LAD during stent delivery attempts. We did not realize this and stented the LAD jailing the prolapsed portion of the wire.

[@doctorcardio3886]

@@manosbrilakis there is an old stent in lad seen on Angio. Did you put fresh stent in lad? Not shown in the video.

[@TheNEF11]

What was the mechanism of the entrapment? did the wire go through the first Stent-strut (LAD-Stent) and knuckled during pulling it back out of the vessel?
thank you very much for sharing & educating! very interesting case!

[@freaktty01]

Thank for sharing. Is it possible to push a ballon or microcatheter over the trapped wire (very) hard into the LAD? To free the distal part?

[@cristimilitaur]

How do you think the wire got trapped? Did it get entangled in the old LAD stent?