Key result
Conservative DAPT maintains clinical stability without stent thrombosis after retained coronary guidewire fracture.
Why the study?
Guidewire entrapment and fracture during PCI remain uncommon but challenging complications whose management depends on fragment location, vessel size, coronary flow, and procedural retrieval risk.
Case Report (n=1)
No
This case highlights the importance of confirming distal guidewire position and free mobility prior to direct stenting to prevent entrapment, and demonstrates that conservative management with dual antiplatelet therapy is appropriate for selected low-risk retained distal guidewire fragments.
May support short-term conservative DAPT after jailed guidewire fragments; leaves open need for prospective data on safety and generalizability.
Guidewire entrapment and fracture during percutaneous coronary intervention (PCI) remain uncommon but challenging complications. Their management depends on fragment location, vessel size, coronary flow, and procedural risk of retrieval. We report the case of a 68-year-old diabetic active smoker admitted for elective PCI after a positive stress echocardiography. Coronary angiography demonstrated balanced coronary circulation with a significant isolated mid obtuse marginal branch stenosis. PCI was performed through left radial access using a BMW guidewire. A direct stenting strategy was selected. During stent deployment, insufficient distal advancement of the guidewire led to wire entrapment within the stent struts. Multiple retrieval attempts using double-wire and balloon-assisted techniques failed. Gentle traction resulted in guidewire fracture, leaving a short radiopaque fragment jailed in a small marginal branch. Repeat angiographic assessment after 48 hours confirmed persistence of the fragment without stent thrombosis or flow limitation. The patient remained clinically stable and asymptomatic. Conservative treatment with dual antiplatelet therapy was continued.
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Hattach Sarah (2026) conducted a case report in Coronary guidewire entrapment and fracture during percutaneous coronary intervention of an obtuse marginal branch stenosis (n=1). Conservative management with dual antiplatelet therapy was evaluated on Stent thrombosis or coronary flow limitation at 48 hours. Conservative management with dual antiplatelet therapy resulted in clinical stability without stent thrombosis or flow limitation at 48 hours after coronary guidewire fracture in a 68-year-old patient.
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