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

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Page 1: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

Multivessel PCI procedure complicated with

fracture of the wire

Marcin Dębinski, MD

Head: Pawel E. Buszman, MD, FACC

University Hospital of Silesia, Katowice, Poland

Page 2: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

Clinical data

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 in LAD / D1 bifurcation, 80-90% long lesion in distal LAD, 99% focal lesion in apical segment of LAD.

– Cx: diffuse disease with 80-90% lesions in distal segment

– OM: 80-90% stenosis– Long, massive calcifications in

LM / LAD

Page 3: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

Surgeon opinion (CABG)

High risk CABG: Age (>70 years) Respiratory insufficiency (COPD) Cerebral perfusion impairment Mildly reduced LVEF Diffuse disease in distal segments of coronary arteries

Intended strategy• Patient disqualified from CABG

• Treatment: multivessel staged PCI procedure: Cx / OM, LAD / D1, RCA

Page 4: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

LCA: coronary angiography before PCI

RAO / CAU LAO / CRAGuiding catheter: EBU 6F Launcher

Page 5: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

1st stage: PCI Cx/OM

Predilatation and stenting of Cx with Pixel 2.5x28 mm (14atm)

Predilatation and stenting of OM with Mac 2.5x22 mm (18atm)

Page 6: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

2nd stage: PCI LAD / D1

Two BMW wires (Universal 0,014”) in LAD and D1. Predilatation of D1 ostium with Viva 2.0x15 baloon (8atm).

Direct stenting with Chopin 3.0x15 mm to LAD (18 atm).

POBA in distal LAD

LAD : TIMI3, no dissection, no residual stenosis.The D1 wire got jammed between the stent struts and vessel wall

Page 7: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

Fracture of the wire during removal from D1

Repeated wireing of LAD and D1 with new wires (2x Pilot 50). POBA ostium of D1 with Viva baloon 2.0x20mm

During wire removal from D1 fractureof the wire occurs (junction between The distal part and the wire core)

Page 8: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

Removal of broken wire

Inflation of 3.0x40mm baloon (8atm) inside the guiding catheter.

Removal of broken wire, inflated baloon and guiding catheter as a whole unit.

Page 9: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

LCA: Final result

LAO / CRA

- Patient was discharged after 2 days - 3rd stage: PCI RCA was made in 2 weeks, without any complications

Removed guiding catheter and wires

Final angio

Page 10: Multivessel PCI procedure complicated with fracture of the wire Marcin D ę binski, MD Head: Pawel E. Buszman, MD, FACC University Hospital of Silesia,

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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