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Multivessel PCI procedure complicated with fracture of the wire

This case study outlines a complicated multivessel percutaneous coronary intervention (PCI) procedure in a 77-year-old male with unstable angina and multiple comorbidities. The procedure involved stenting of the left main coronary artery, left anterior descending artery, circumflex artery, and right coronary artery. However, complications arose during the removal of a wire, resulting in its fracture. The case study highlights the importance of careful wire selection and avoiding high pressure during stent deployment to prevent such complications.

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Multivessel PCI procedure complicated with fracture of the wire

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  1. Multivessel PCI procedure complicated with fracture of the wire Marcin Dębinski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia, Katowice, Poland

  2. Male, 77 years old Unstable angina- CCS IV Arterial hypertension COPD Paroxysmal atrial fibrillation ECHO: LVEF=45%, general mild hypokinesis, evidence of pulmonary hypertension Transcranial UDP Doppler: flow velocity reduction in posterior cerebral region RCA: medial 50% stenosis distal 80% stenosis LCA: LM:no stenosis LAD: critical 95% stenosis located inLAD/D1 bifurcation, 80-90% long lesionin distal LAD, 99% focal lesion in apical segment of LAD. Cx: diffuse disease with80-90% lesions in distal segment OM: 80-90% stenosis Long, massive calcifications in LM / LAD Clinical data

  3. Surgeon opinion (CABG) • High risk CABG: • Age (>70 years) • Respiratory insufficiency (COPD) • Cerebral perfusion impairment • Mildly reducedLVEF • Diffuse disease in distal segments of coronary arteries Intended strategy • Patient disqualified from CABG • Treatment: multivessel staged PCI procedure: Cx / OM, LAD/D1, RCA

  4. LCA: coronary angiography before PCI RAO / CAU LAO / CRA Guiding catheter: EBU 6F Launcher

  5. 1st stage: PCICx/OM Predilatation and stenting of Cx with Pixel 2.5x28mm (14atm) Predilatation and stenting of OM with Mac 2.5x22 mm (18atm)

  6. 2nd stage:PCI LAD/D1 Two BMW wires (Universal 0,014”) in LAD and D1. Predilatation of D1ostium with Viva 2.0x15 baloon (8atm). Direct stenting with Chopin 3.0x15 mm to LAD(18 atm). LAD : TIMI3, no dissection, no residual stenosis.The D1 wire got jammed between the stent struts and vessel wall POBA in distal LAD

  7. Fracture of the wire during removal from D1 During wire removal from D1 fracture of the wire occurs (junction between The distal part and the wire core) Repeated wireing of LAD and D1 with new wires (2x Pilot 50). POBA ostium of D1 with Viva baloon 2.0x20mm

  8. Removal of broken wire Removal of broken wire, inflated baloon and guiding catheter as a whole unit. Inflation of 3.0x40mm baloon (8atm) inside the guiding catheter.

  9. LCA: Final result Removed guiding catheter and wires Final angio LAO / CRA - Patient was discharged after 2 days - 3rd stage: PCI RCA was made in 2 weeks, without any complications

  10. Take home message • Avoid high pressure inflations during stenting of main vessel when wire is in side branch (especially in calclified vessels) • Choose and check the wire carefully in above situation • Hydrophilic wire is probably the best choice • High inflation pressure beacause of incomplete stent expansion • LAD calclifications • Probable malfunction of BMW Universal wire 0,014``(weak element connection, rough surface between component connection)

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