Key result
Hybrid trans-brachial cutdown with endoluminal traction successfully retrieves fractured guidewire after failed percutaneous attempts.
Why the study?
Guidewire fracture during PCI is a rare but serious complication with management strategies dependent on fracture characteristics and lacking standardized retrieval approaches.
Case Report (n=1)
No
A minimally invasive hybrid approach combining trans-brachial arteriotomy with endoluminal traction provides a safe and effective salvage strategy for retrieving fractured PCI guidewires, avoiding the trauma of traditional open-heart surgery.
May offer a minimally invasive salvage for refractory guidewire fractures; leaves open validation in larger cohorts.
Background: Guidewire fracture during percutaneous coronary intervention (PCI) is rare but serious, with management dependent on fracture characteristics. We report an innovative minimally invasive hybrid approach for this complication. Case summary: A 59-year-old male with diabetes/hypertension developed Sion guidewire fracture during LAD PCI. Percutaneous retrieval failed; conservative therapy was initially given. A minimally invasive hybrid "trans-brachial arteriotomy with endoluminal traction" retrieved the fragment 34 days post-fracture, with uneventful recovery. Discussion: Guidewire fracture occurs in 0.2%-0.8% of PCI cases. Histopathological evidence suggests that at 34 days, incomplete endothelialization facilitates rather than hinders retrieval. Although no standard retrieval window exists, delayed elective retrieval can achieve high success rates in stable patients. Traditional open surgery is traumatic; our hybrid approach avoids sternotomy, offering a novel salvage strategy valuable for interventional cardiologists and surgeons. Take home messages: Minimally invasive hybrid retrieval is safe and effective for PCI guidewire fractures refractory to percutaneous methods, emphasizing the value of multidisciplinary collaboration.
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Dai et al. (2026) conducted a case report in Sion guidewire fracture during percutaneous coronary intervention (n=1). Minimally invasive hybrid trans-brachial arteriotomy with endoluminal traction vs. Percutaneous retrieval methods (failed) and conservative management was evaluated on Successful retrieval of the guidewire fragment. A minimally invasive hybrid trans-brachial arteriotomy with endoluminal traction successfully retrieved a fractured Sion guidewire 34 days post-fracture after failed percutaneous attempts.
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