Transcript wire_fracture_PCR2007

Multivessel PCI procedure
complicated with
fracture of the wire
Marcin Dębinski, MD
Head: Pawel E. Buszman, MD, FACC
University Hospital of Silesia, Katowice, Poland
Clinical data
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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
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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 8090% lesions in distal segment
OM: 80-90% stenosis
Long, massive calcifications in
LM / LAD
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
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Patient disqualified from CABG
Treatment: multivessel staged PCI procedure:
Cx / OM, LAD / D1, RCA
LCA: coronary angiography
before PCI
RAO / CAU
LAO / CRA
Guiding catheter: EBU 6F Launcher
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)
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).
LAD : TIMI3, no dissection, no residual stenosis.
The D1 wire got jammed between
the stent struts and vessel wall
POBA in distal LAD
Fracture of the wire during
removal from D1
During wire removal from D1 fracture
of the wire occurs (junction between
The distal part and the wire core)
Repeated wireing of LAD and D1 with
new wires (2x Pilot 50). POBA ostium
of D1 with Viva baloon 2.0x20mm
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.
LCA: Final result
Removed guiding
catheter and wires
Final angio
LAO / CRA
- Patient was discharged after 2 days
- 3rd stage: PCI RCA was made in 2 weeks, without any complications
Take home message
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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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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
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