Retrieval of trapped and broken guide wire with immediate rescue off-pump coronary bypass surgery

The entrapment, fracture and dislodgement of diagnostic or therapeutic devices within the coronary circulation during a procedure are a rare complication occurring in 0.2-0.8% of cases. Despite technological improvements, this complication is still occurring because coronary angioplasty is often undertaken for complex anatomical situations. The complication of device fracture during the intervention procedure occurs due to entrapment, overcoiling and excessive traction of the guide wire. There has been no agreement as to whether and by which technique the immediate removal of the broken fragment of guide wire should be done. Here, we report a case of anterolateral myocardial infarction who underwent primary percutaneous coronary intervention. During the procedure, the guide wire was entrapped within the left anterior descending coronary artery. Despite many attempts, the wire could not be removed and even became fractured at the femoral insertion site; thus, urgent surgical removal of the wire with vessel grafting was done with a successful outcome. This gives a clear message about the importance of the ready availability of surgical backup and, particularly, the necessity for complex percutaneous interventions.