CHICKEN OR THE EGG: RETAINED FRACTURED CORONARY WIRE FRAGMENT FROM A REMOTE PCI CAUSING AORTIC VALVE LEAFLET LACERATION AND SEVERE AORTIC REGURGITATION DURING A SUBSEQUENT PCI
Presenter
Somto Nwaedozie, MD, Marshfield Clinic Heart Care, MARSHFIELD, WI
Somto Nwaedozie, MD1, Shoaib Khan2 and Boban Mathew1, (1)Marshfield Clinic Heart Care, MARSHFIELD, WI, (2)UHS Wilson Medical Center, Johnson City, NY
Title
CHICKEN OR THE EGG: RETAINED FRACTURED CORONARY WIRE FRAGMENT FROM A REMOTE PCI CAUSING AORTIC VALVE LEAFLET LACERATION AND SEVERE AORTIC REGURGITATION DURING A SUBSEQUENT PCI. Introduction
Iatrogenic Aortic Valve leaflet laceration following coronary intervention is a rare but potentially life-threatening complication of coronary intervention that can be caused by a fractured coronary wire protruding into the aorta.
Clinical Case
A 60-year-old female with a known history of hypertension, hyperlipidemia, type 2 Diabetes Mellitus, and Coronary artery disease presents with substernal chest pain and was found to have a Non-ST elevation acute coronary syndrome about one year ago. She had a mid-LAD PCI, complicated by a fractured intra-coronary wire. As this was unable to be retrieved, it was stented against the coronary wall. The proximal end of the unraveled wire was protruding into the aorta, but was not noted at the time. During the index presentation, she underwent proximal LAD PCI with stenting, but 2 days afterward, she developed acute decompensated heart failure. Echocardiography revealed a new eccentric severe aortic regurgitation. A linear echogenic structure was seen in the ascending aorta (Fig 1A). Chest CT ruled out a dissection. She underwent a surgical aortic valve replacement, and intra-op findings confirmed retained wire fragment protruding from the left coronary artery and a linear fenestrated tear of the noncoronary cusp of the aortic valve. (Fig. 1B)
Discussion
Coronary intervention guidewire fracture and entrapment, although rare, can result in distal vessel occlusion, proximal embolization, vessel dissection, laceration of surrounding structures or heightened risk of subsequent coronary interventions. Percutaneous or surgical retrieval might be necessary to avoid such complications. Interventional operators should be aware of this uncommon complication and measures to avoid and appropriately manage it.