Transradial Endomyocardial Biopsy Forceps Bailout for Aorto-Ostial Guidewire Fracture: 24-Month Safety Follow-Up.

BACKGROUND: Coronary guidewire fracture complicates 0.1% to 0.2% of percutaneous coronary interventions. Aorto-ostial fragments pose retrieval challenges due to acute angulation and valve proximity. CASE SUMMARY: During left anterior descending chronic total occlusion percutaneous coronary intervention in a 58-year-old man, a right coronary artery guidewire fractured at the calcified ostium with aortic protrusion. After 55 minutes of unsuccessful conventional retrieval, endomyocardial biopsy forceps were advanced through right radial access under orthogonal fluoroscopic views with surgical standby. The fragment was secured and withdrawn in <8 minutes. DISCUSSION: To our knowledge, this represents the first reported transradial biopsy forceps retrieval of an aorto-ostial guidewire fragment. A 24-month echocardiography confirmed preserved valve integrity. This highly selective bailout requires strict prerequisites: ≥1 cm protrusion, endomyocardial biopsy experience, orthogonal imaging, and immediate surgical backup. TAKE-HOME MESSAGE: When conventional techniques fail for aorto-ostial guidewire fractures with adequate aortic protrusion, transradial biopsy forceps retrieval offers a last-resort option in experienced hands with surgical standby.