Guidewire complications

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List of terms related to Guidewire complications

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The use of coronary guidewires can be associated with perforation of the epicardial coronary artery, entrapment of the wire in the vessel, and detachment or embolization of the wire tip. This chapter discusses the management of these complications.

Guidewire Entrapment

May occur with

• calcified vessels ( eg RCA) at the tip.

May be prevented by avoiding using the same wire on multiple interventions or multiple crossing.

My need to advance a small profle balloon or a small caliber catheter (transit) to the “attachement” site and use traction. Caution : Perforation.

• May occur when a buddy wire gets trapped between a stent and the vessel wall. Gentle traction may bring the wire out of the stent. The coating of the tip may “deglove” and be left behind, which could be “pushed and pasted” against the vessel wall with another stent. May need surgery to retrieve it. The tip may completely detach, then the management is as above.

DETACHMENT OR EMBOLISATION OF END OF THE WIRE

Uncommon with most modern wires.

Management

There is no data to guide management. Clinical judgment should be used.

May have to snare it.

May be left in situ, speacially if small and unable to retrieve. Could use a stent to “push and paste” it to the vessel wall.

Surgery may be needed.

WIRE FRACTURE IN A CORONARY VESSEL

This should be identified immediately and the wire should be replaced. It could give rise to the situations mentioned above.