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Guidewire Fracture, Entrapment in Proximal Left Anterior Descending and Successful Extraction with Snare Catheter

Uditha Indika Hewarathne*, Ajith Indika Kularatne, S hanike Prasad Karunarathne, Dolapihilla SNB, Thilini Dayaratne

A 64 year old female patient with a history of dyslipidaemia presented with Canadian Cardiovascular Society class II angina and stage 1 positive treadmill stress test. Coronary angiogram revealed 20% stenosis in distal left main coronary artery (LMCA), two 95% stenosis in proximal left anterior descending artery (LAD) and non-significant disease in left circumflex and right coronary arteries. LAD lesion was crossed with Rinato guidewire and first diagonal branch (D1) crossed with BMW guidewire. Both proximal and distal LAD lesions were predilated and stented with 2.75 × 38 mm Xience prime (Everolimus Eluting) stent. After the stent implantation, jailed guidewire used to protect the diagonal branch could not be removed. Traction, pull and push, balloon reinflation and deflation, back-and-fourth vibration were attempted to no avail. Finally guidewire fracture occurred and eventually entrapment leaving a part in D1, LAD and LMCA. By using an endovascular snare system we were able to remove the fractured guidewire successfully. This case highlights that endovascular snare system can safely and effectively be used for extraction of fractured retained guidewires inside the coronary arteries which prevents impending surgical intervention.