Handmade Embolization Coil for Managing Guidewire-Induced Coronary Perforation

Figures

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  Figure 1. Percutaneous Coronary Intervention for a Left Circumflex Artery Lesion (A) Target lesion in the mid-left circumflex artery indicated by arrowheads. (B) Tapered guidewire passes through the lesion but advances into the side branch (circle). (C) Post-percutaneous coronary intervention angiography reveals extravascular leakage of contrast medium (dotted circle).

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  Figure 2. Implantation of a Commercial Curled Microcoil at the Bleeding Point Through the MC (A) Zizai MC (arrowhead) inserted into the bleeding side branch. (B) Tip contrast injection indicates the bleeding point. (C) Embolization microcoil (Hilal Curl 10 mm, Cook) (arrowheads) deployed through the MC. (D to F) Microcoil reaches the MC tip, causing it to bend to fit the shape of the curled microcoil, leading to slippage out of the side branch. MC = microcatheter.

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  Figure 3. Preparing the Handmade Coil (A and B) GW tip introduced into the inserter from the tip outside the body. (C) Fluoroscopy adjustment of GW length within the inserter (arrowhead). (D and E) GW cut using scissors at the inserter tip. (F) GW fragment (2-headed arrow) pushed into the microcatheter. GW = guidewire; MC = microcatheter.

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  Figure 4. Handmade Coil Is Placed at the Bleeding Point (A to C) Microcatheter advances GW fragment (arrowheads) to the bleeding point, unlike with the curled coil. (D) Handmade coil (arrowheads) successfully achieves hemostasis. GW = guidewire.