Multivessel PCI procedure complicated with fracture of the wire

1
Multivessel PCI procedure complicated with
fracture of the wire

• Marcin Debinski, MD
• Head Pawel E. Buszman, MD, FACC
• University Hospital of Silesia, Katowice, Poland

2
Clinical data

• RCA
• medial 50 stenosis
• distal 80 stenosis
• LCA
• LM no stenosis
• LAD critical 95 stenosis located in LAD / D1
  bifurcation, 80-90 long lesion in distal LAD,
  99 focal lesion in apical segment of LAD.
• Cx diffuse disease with 80-90 lesions in distal
  segment
• OM 80-90 stenosis
• Long, massive calcifications in LM / LAD

• Male, 77 years old
• Unstable angina- CCS IV
• Arterial hypertension
• COPD
• Paroxysmal atrial fibrillation
• ECHO LVEF45, general mild hypokinesis,
  evidence of pulmonary hypertension
• Transcranial UDP Doppler flow velocity reduction
  in posterior cerebral region

3
Surgeon opinion (CABG)

• High risk CABG
• Age (gt70 years)
• Respiratory insufficiency (COPD)
• Cerebral perfusion impairment
• Mildly reduced LVEF
• Diffuse disease in distal segments of coronary
  arteries

• Intended strategy
• Patient disqualified from CABG
• Treatment multivessel staged PCI procedure Cx
  / OM, LAD / D1, RCA

4
LCA coronary angiography before PCI
RAO / CAU
LAO / CRA
Guiding catheter EBU 6F Launcher
5
1st stage PCI Cx/OM
Predilatation and stenting of Cx with Pixel
2.5x28 mm (14atm)
Predilatation and stenting of OM with Mac 2.5x22
mm (18atm)
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2nd stage PCI LAD / D1
Two BMW wires (Universal 0,014) in LAD and D1.
Predilatation of D1 ostium with Viva 2.0x15
baloon (8atm).
Direct stenting with Chopin 3.0x15 mm to LAD (18
atm).
LAD TIMI3, no dissection, no residual
stenosis.The D1 wire got jammed between the
stent struts and vessel wall
POBA in distal LAD
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Fracture of the wire during removal from D1
During wire removal from D1 fracture of the wire
occurs (junction between The distal part and the
wire core)
Repeated wireing of LAD and D1 with new wires
(2x Pilot 50). POBA ostium of D1 with Viva
baloon 2.0x20mm
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Removal of broken wire
Removal of broken wire, inflated baloon and
guiding catheter as a whole unit.
Inflation of 3.0x40mm baloon (8atm) inside the
guiding catheter.
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LCA Final result
Removed guiding catheter and wires
Final angio
LAO / CRA
- Patient was discharged after 2 days - 3rd
stage PCI RCA was made in 2 weeks, without any
complications
10
Take home message

• High inflation pressure beacause of incomplete
  stent expansion
• LAD calclifications
• Probable malfunction of BMW Universal wire
  0,014(weak element connection, rough surface
  between component connection)

• Avoid high pressure inflations during stenting of
  main vessel when wire is in side branch
  (especially in calclified vessels)
• Choose and check the wire carefully in above
  situation
• Hydrophilic wire is probably the best choice