Key result
Emergent CABG enables successful retrieval of an entrapped coronary guidewire after failed percutaneous extraction.
Why the study?
Retained coronary guidewire fracture with proximal systemic extension is a rare but potentially life-threatening complication of PCI requiring guidance on management strategies.
Case Report (n=1)
Failed percutaneous retrieval of a retained fractured coronary guidewire with proximal systemic extension should prompt early multidisciplinary surgical evaluation for extraction.
May support early surgical escalation in systemic guidewire fractures; leaves open optimal strategies from observational data alone.
BACKGROUND: Retained coronary guidewire fracture with proximal systemic extension is a rare but potentially life-threatening complication of percutaneous coronary intervention, occurring in approximately 0.02% to 0.08% of procedures. CASE SUMMARY: A 66-year-old man with myocardial infarction underwent intravascular ultrasound-guided percutaneous coronary intervention for subtotal right coronary artery occlusion. High-pressure post-dilation of overlapping drug-eluting stents caused guidewire entrapment, fracture, and proximal extension into the ascending aorta and right subclavian artery. Following failed percutaneous retrieval, emergent coronary artery bypass grafting with aortotomy enabled extraction of 35.5 cm of guidewire while a 2.5-cm distal coronary fragment was intentionally retained. The patient recovered without recurrent ischemia and was discharged on clopidogrel and rivaroxaban. DISCUSSION: Proximal systemic extension beyond the coronary ostium represented the inflection point for surgical escalation. A structured review of 23 published cases supports a practical location- and risk-based management framework. TAKE-HOME MESSAGE: Failed percutaneous retrieval with proximal systemic extension beyond the coronary ostium should prompt early multidisciplinary surgical evaluation.
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Mategaonkar et al. (2026) conducted a case report in Retained coronary guidewire fracture with proximal systemic extension (n=1). Emergent coronary artery bypass grafting with aortotomy was evaluated. Emergent coronary artery bypass grafting successfully enabled extraction of a fractured coronary guidewire with proximal systemic extension after failed percutaneous retrieval in a 66-year-old man.
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