IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Surgical Release of Trapped Guidewire after Coronary Angioplasty and Stenting
Christophoros Kotoulas, PhD, Fetcs, FCCP,
Ioannis Stathopoulos, MD,
Ioannis Koukis, MD,
Konstantinos Patris, MD
Cardiothoracic Department, Central Clinic of Athens, Athens, Greece
Christophoros Kotoulas, PhD, FETCS, FCCP, Tel: +30 210 778 2220, Fax: +30 210 777 2329, Email: info{at}kotoulas.com, Kifissias 38, Ampelokipi, GR-115 26 Athens, Greece.
An 81-year-old woman presented with angina. Coronary angiography revealed 95% stenosis of the left anterior descending artery (LAD), before the first diagonal branch. Two guidewires were inserted into the LAD and diagonal, and two stents were advanced into the LAD. At the end of the procedure, the LAD guidewire could be removed easily, but the other one was trapped between the proximal stent and the arterial wall and was impossible to release (Figure 1
). Urgent surgical removal was decided, to avoid myocardial infarction. The patient was fully anticoagulated with heparin. After a median sternotomy, cardiopulmonary bypass was instituted at normothermia. The LAD was exposed, the stents were removed from the LAD, and the guidewire was removed from the diagonal branch (Figure 2). After release of the crossclamp, the guidewire was withdrawn with no further problem. A saphenous vein graft was used to patch and bypass the LAD lesion and to compensate for any possible damage that removal of the stents might have caused to the vessel. The patient recovered uneventfully.
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Figure 1. Stents in the left anterior descending artery (thin arrows), and the guidewire in the first diagonal branch (thick arrow).
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Figure 2. Operative photograph showing the stents in the left anterior descending artery (thick arrow), and the guidewire in the first diagonal branch (thin arrow).
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Asian Cardiovasc Thorac Ann 2009;
17:439
© 2009 by SAGE Publications
DOI: 10.1177/0218492309343853
