Stuck in Reverse: A Confusing Case of Failure to Withdraw a Wire into a Micro-Catheter
Presenter
Basem Elbarouni, M.B.B.S., St. Boniface General Hospital, Winnipeg, MB, Canada
Basem Elbarouni, M.B.B.S., St. Boniface General Hospital, Winnipeg, MB, Canada
Title
Stuck in Reverse: A Confusing case of Failure to withdraw a wire into a Microcatheter Introduction
CTO PCI are complex procedures in which unusual challenges are sometimes faced. In this case we were able to wire a calcified lesion, and with difficulty cross with a micro-catheter. However we could not retrieve the wire into the micro-catheter. We eventually recognized the cause of this unusual scenario.
Clinical Case
A 66 year old female was referred for Coronary angiography with CCS III angina despite two anti-anginal medications. Coronary angiography revealed a right dominant circulation. The left main, LAD and circumflex were free of significant disease. There were faint septal collaterals from the LAD to the PDA. The RCA had a sub-totally occluded RCA with a tortuous micro-channel. The operator attempted ad-hoc PCI unsuccessfully, and referred the patient to the CTO program.
The procedure was done with dual 7 French access (right radial and right femoral). Antegrade wire escalation was attempted. After failing with several hydrophilic wires, we were ultimately successful in crossing the lesion with a Gaia 3rd wire into the distal true lumen. A Turnpike Spiral micro-catheter failed to cross the lesion. Balloon assisted modification (Grenadoplasty) was performed, and a new Turnpike Spiral successfully crossed the lesion. However, we were unsuccessful in retrieving the wire into the micro-catheter. Multiple maneuvers were tried, including sub-intimal plaque modification and switching to a FineCross. We were even successful in pre-dilating the lesion with a non compliant balloon. We noted a radio-lucent spot in the wire, suggesting partial wire fracture. Using a TwinPass, we were able to advance a new wire across the lesion and remove the original damaged wire. PCI was completed successfully. A distal wire perforation was sealed with fat embolization. Close inspection of the removed wire demonstrated partial stripping of the wire.
Discussion
Wire fatigue and stripping should be considered when failing to withdraw a wire into the micro-catheter.
A dual lumen catheter can be useful to maintain distal access while removing the damaged wire