The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

Dear Editor, Advancements in invasive coronary angiography and accumulated experience have improved the success of interventions in challenging coronary artery lesions and associated complications. However, the approach and success in managing rare complications such as guide wire entrapment depend on the patient's hemodynamic status, continuity of coronary flow, capabilities of the angiography laboratory and the operator's expertise. In this letter, we present a case of guide wire entrapment during coronary intervention, the difficulties encountered during percutaneous removal attempts, and the finally applied conservative approach. Patient Information A 56-year-old male, known for active smoking and a history of three-vessel coronary bypass surgery four years ago, presented with pressing chest pain. The patient had undergone coronary angiography (CAG) a year ago, and medical follow-up was recommended. Due to the diagnosis of unstable angina pectoris, the patient underwent another angiography. Following the stent implantation for significant stenosis after the anastomosis in the saphenous-LAD graft, attempts to retrieve the guidewire resulted in stent deformation (Fig. 1) and entrapment. Despite efforts to retract the guidewire, it was unsuccessful. Subsequently, the case was urgently taken over, maintaining the catheter and guidewire in a sterile manner (Fig. 1). After obtaining cardiovascular surgical consultations, a decision was made to reattempt the procedure through percutaneous coronary intervention. After ensuring proper field cleanliness, the procedure began by confirming the absence of catheter thrombus. It was observed that there was no distal flow in the first images (Fig. 2). Attempts to enter the stent with a 1.0x12 mm Artimes balloon were unsuccessful, and after the balloon's deformation, a second attempt was made with another balloon but was also unsuccessful. Microcatheters were used to enter the stent, but they got trapped, and only after various manipulations, the microcatheter could be retracted. Subsequent attempts with PT-2 and Fielder XT-A Guidewires for the buddy wire technique were unsuccessful due to entrapment between stent struts (Fig. 1). Considering the thinness of the distal vessel and the chronic near 99% stenosis similar to previous CAG images, it was decided to attempt distal wire detachment due to the high surgical risk in this patient. However, despite attempts, the wire did not detach. During the wire retraction, the h