Surgical revascularization in acute coronary syndrome patient after
failed PCI with broken angioplasty wire protruding into aortic root.
Abstract
Percutaneous coronary interventions (PCI) have an established position
in the management of patients presenting with acute coronary syndromes
and stable coronary artery disease with low complications rates. We
present the case of a 67-year-old male referred for urgent coronary
catheterization intervention with anterior wall ST-elevation myocardial
infarction diagnosis. After stent implantation, the wires were removed
however a part of the wire was entrapped in the coronary artery. The
metallic coil covering the core of the angioplasty wire was left in
proximal part of LAD and protruded into the aortic root. Patient was
referred for emergency surgical procedure that was performed through
median sternotomy in cardiopulmonary bypass (CPB) and moderate
hypothermia. After transverse aortotomy, the foreign body of 7 cm in
length was found irremovable, it was transected and left in the proximal
portion of the left main coronary artery (LM). The decision to perform
revascularization of LAD, CX and RCA was undertaken. The estimated graft
blood flow measurements were satisfactory with the values of 7 mL/min in
LIMA-to-LAD graft, 39 mL/min in SVBG-to-CX and 43 mL/min in SVBG-to-RCA,
respectively. The patient’s postoperative course was uneventful. Cardiac
surgery is a reasonable method of treatment in patients with coronary
artery disease and PCI complicated with entrapment of broken guidewire
protruding in aortic root.