INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.319 |
Resumo: | Introduction: Guidewire fracture is a rare complication of percutaneous coronary intervention (PCI). Retained fragments can cause thrombosis, dissection, perforation of the vessel or embolize. When is impossible to withdraw or to trap the fragment during the procedure, management is debatable between surgical removal or conservative approach. When choosing to leave the fragment in place, the patient remains at risk for all of the aforementioned complications. Clinical Case: 65-year-old male patient submitted to PCI with stenting of distal right coronary artery in 2017. A proximal optimization technique was performed, with a guidewire placed in the posterior descending artery (PDA). After stenting, the protection guidewire became entrapped and after several retrieval attempts, it fractured. Wire fragment remained within the RCA and ascending aorta with a free mobile distal part in the beginning of the innominate artery. Multiple attempts went in vain for wire retrieval and a conservative approach was adopted. Two and a half years later, the patient felt a sudden chest pain and then collapsed. He was transferred to our Hospital for emergent surgery due to cardiac tamponade. Intra-operatively, cardiac surgeons found the guidewire perforating the posterior descending artery. When trying to pull it out, the guidewire fractured again. Post-intervention CTA revealed migration of the fragmented guidewire now it was entrapped in a tortuous initial portion of the right internal carotid artery and a small pseudoaneurysm was visible at the distal portion of the wire. Surgical approach was performed revealing the presence of the wire within the carotid medial wall, in a subintimal plane. The 7 cm fragment was successfully withdrawn, through a common carotid transverse incision. Pseudoaneurismectomy was performed and carotid artery bifurcation reconstruction with internal carotid artery re-implantation into the bifurcation, end-to-end anastomosis. The patient had an uneventful postoperative course. Conclusion: Although leaving the wire in place remains an option, coronary guidewire fractured fragments can be associated not only with immediate complications but also with potential adverse events in the long run. |
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INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROWPSEUDOANEURISMA DA ARTÉRIA CATÓTIDA INTERNA CAUSADO POR MIGRAÇÃO DE FRAGMENTO DE FIO-GUIA CORONÁRIOpercutaneous coronary intervention complicationsbroken guidewireguidewire embolizationforeign body in ascending aortacardiac tamponadeinternal carotid pseudoaneurysmcomplicações da intervenção coronária percutâneafratura de fio-guiamigração de fio guiatamponamento cardíacopseudoaneurisma da artéria carótida internaIntroduction: Guidewire fracture is a rare complication of percutaneous coronary intervention (PCI). Retained fragments can cause thrombosis, dissection, perforation of the vessel or embolize. When is impossible to withdraw or to trap the fragment during the procedure, management is debatable between surgical removal or conservative approach. When choosing to leave the fragment in place, the patient remains at risk for all of the aforementioned complications. Clinical Case: 65-year-old male patient submitted to PCI with stenting of distal right coronary artery in 2017. A proximal optimization technique was performed, with a guidewire placed in the posterior descending artery (PDA). After stenting, the protection guidewire became entrapped and after several retrieval attempts, it fractured. Wire fragment remained within the RCA and ascending aorta with a free mobile distal part in the beginning of the innominate artery. Multiple attempts went in vain for wire retrieval and a conservative approach was adopted. Two and a half years later, the patient felt a sudden chest pain and then collapsed. He was transferred to our Hospital for emergent surgery due to cardiac tamponade. Intra-operatively, cardiac surgeons found the guidewire perforating the posterior descending artery. When trying to pull it out, the guidewire fractured again. Post-intervention CTA revealed migration of the fragmented guidewire now it was entrapped in a tortuous initial portion of the right internal carotid artery and a small pseudoaneurysm was visible at the distal portion of the wire. Surgical approach was performed revealing the presence of the wire within the carotid medial wall, in a subintimal plane. The 7 cm fragment was successfully withdrawn, through a common carotid transverse incision. Pseudoaneurismectomy was performed and carotid artery bifurcation reconstruction with internal carotid artery re-implantation into the bifurcation, end-to-end anastomosis. The patient had an uneventful postoperative course. Conclusion: Although leaving the wire in place remains an option, coronary guidewire fractured fragments can be associated not only with immediate complications but also with potential adverse events in the long run. Introdução: A fratura do fio-guia durante uma intervenção coronária percutânea (ICP) é uma complicação rara. Os fragmentos retidos podem provocar trombose, disseção ou perfuração do vaso ou até mesmo embolizar para outros territórios. Quando é impossível recuperar ou aprisionar o fragmento durante o procedimento inicial, a abordagem seguinte é questionável entre uma remoção cirúrgica ou uma abordagem mais conservadora. Quando a segunda opção é a escolhida, a eventualidade de ocorrência de qualquer uma das complicações acima referidas mantém-se. Caso Clínico: Doente de 65 anos, submetido a ICP com stenting da coronária direita (ACD) em 2017. Para tal foi utilizada uma proximal optimization technique, com colocação de fio-guia na descendente posterior (ADP). Após o stenting, o fio de proteção ficou preso e após várias tentativas de remoção acabou por fraturar. O fragmento encontrava-se ao longo do interior da ACD e aorta ascendente, com a sua porção proximal localizada a nível do tronco arterial braquiocefálico. Múltiplas tentativas de remoção endovascular foram tentadas em vão, optando-se por uma estratégia conservadora. Dois anos e meio depois, o doente sente uma precordialgia aguda, acabando por colapsar. É transferido para a nossa Instituição onde é submetido a cirurgia cardíaca urgente. Intra-operatoriamente é constatada a presença do fragmento do fio-guia a perfurar a ADP. Este mesmo fragmento, ao ser puxado na tentativa de ser recuperado, volta a fraturar. O angioTC pós-intervenção revelou uma migração cefálica do restante fragmento agora encontrando-se retido na artéria carótida comum e porção inicial da artéria carótida interna direitas, visualizando-se um falso aneurisma a nível da extremidade distal do fragmento. O doente foi submetido a cirurgia carotídea, recuperando-se o fragmento através de uma incisão transversal da artéria carótida comum. Foi realizada pseudoaneurismectomia, com reimplantação da artéria carótida interna na bifurcação carotídea através de uma anastomose topo-a-topo. O pós-operatório decorreu sem complicações. Conclusão: Apesar de o tratamento conservador poder ser uma opção, os fragmentos secundários a fratura de fio-guia podem associar-se não só a complicações imediatas como também a complicações associadas a risco de vida a longo prazo, tal como demonstrado neste caso. Sociedade Portuguesa de Angiologia e Cirurgia Vascular2020-12-13T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.319oai:ojs.acvjournal.com:article/319Angiologia e Cirurgia Vascular; Vol. 16 No. 3 (2020): September; 191-194Angiologia e Cirurgia Vascular; Vol. 16 N.º 3 (2020): Setembro; 191-1942183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/319https://doi.org/10.48750/acv.319http://acvjournal.com/index.php/acv/article/view/319/208Copyright (c) 2020 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCoelho, Nuno HenriquesMonteiro, PedroAugusto, RitaPinto, EveliseSemião, CarolinaRibeiro, JoãoPeixoto, JoãoFernandes, LuísGouveia, RicardoMartins, VictorCanedo, Alexandra2022-05-23T15:10:10Zoai:ojs.acvjournal.com:article/319Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:40.999399Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW PSEUDOANEURISMA DA ARTÉRIA CATÓTIDA INTERNA CAUSADO POR MIGRAÇÃO DE FRAGMENTO DE FIO-GUIA CORONÁRIO |
title |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
spellingShingle |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW Coelho, Nuno Henriques percutaneous coronary intervention complications broken guidewire guidewire embolization foreign body in ascending aorta cardiac tamponade internal carotid pseudoaneurysm complicações da intervenção coronária percutânea fratura de fio-guia migração de fio guia tamponamento cardíaco pseudoaneurisma da artéria carótida interna |
title_short |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
title_full |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
title_fullStr |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
title_full_unstemmed |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
title_sort |
INTERNAL CAROTID PSEUDOANEURYSM CAUSED BY MIGRATION OF A CORONARY GUIDEWIRE FRAGMENT: A CASE OF A BROKEN ARROW |
author |
Coelho, Nuno Henriques |
author_facet |
Coelho, Nuno Henriques Monteiro, Pedro Augusto, Rita Pinto, Evelise Semião, Carolina Ribeiro, João Peixoto, João Fernandes, Luís Gouveia, Ricardo Martins, Victor Canedo, Alexandra |
author_role |
author |
author2 |
Monteiro, Pedro Augusto, Rita Pinto, Evelise Semião, Carolina Ribeiro, João Peixoto, João Fernandes, Luís Gouveia, Ricardo Martins, Victor Canedo, Alexandra |
author2_role |
author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Coelho, Nuno Henriques Monteiro, Pedro Augusto, Rita Pinto, Evelise Semião, Carolina Ribeiro, João Peixoto, João Fernandes, Luís Gouveia, Ricardo Martins, Victor Canedo, Alexandra |
dc.subject.por.fl_str_mv |
percutaneous coronary intervention complications broken guidewire guidewire embolization foreign body in ascending aorta cardiac tamponade internal carotid pseudoaneurysm complicações da intervenção coronária percutânea fratura de fio-guia migração de fio guia tamponamento cardíaco pseudoaneurisma da artéria carótida interna |
topic |
percutaneous coronary intervention complications broken guidewire guidewire embolization foreign body in ascending aorta cardiac tamponade internal carotid pseudoaneurysm complicações da intervenção coronária percutânea fratura de fio-guia migração de fio guia tamponamento cardíaco pseudoaneurisma da artéria carótida interna |
description |
Introduction: Guidewire fracture is a rare complication of percutaneous coronary intervention (PCI). Retained fragments can cause thrombosis, dissection, perforation of the vessel or embolize. When is impossible to withdraw or to trap the fragment during the procedure, management is debatable between surgical removal or conservative approach. When choosing to leave the fragment in place, the patient remains at risk for all of the aforementioned complications. Clinical Case: 65-year-old male patient submitted to PCI with stenting of distal right coronary artery in 2017. A proximal optimization technique was performed, with a guidewire placed in the posterior descending artery (PDA). After stenting, the protection guidewire became entrapped and after several retrieval attempts, it fractured. Wire fragment remained within the RCA and ascending aorta with a free mobile distal part in the beginning of the innominate artery. Multiple attempts went in vain for wire retrieval and a conservative approach was adopted. Two and a half years later, the patient felt a sudden chest pain and then collapsed. He was transferred to our Hospital for emergent surgery due to cardiac tamponade. Intra-operatively, cardiac surgeons found the guidewire perforating the posterior descending artery. When trying to pull it out, the guidewire fractured again. Post-intervention CTA revealed migration of the fragmented guidewire now it was entrapped in a tortuous initial portion of the right internal carotid artery and a small pseudoaneurysm was visible at the distal portion of the wire. Surgical approach was performed revealing the presence of the wire within the carotid medial wall, in a subintimal plane. The 7 cm fragment was successfully withdrawn, through a common carotid transverse incision. Pseudoaneurismectomy was performed and carotid artery bifurcation reconstruction with internal carotid artery re-implantation into the bifurcation, end-to-end anastomosis. The patient had an uneventful postoperative course. Conclusion: Although leaving the wire in place remains an option, coronary guidewire fractured fragments can be associated not only with immediate complications but also with potential adverse events in the long run. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-13T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.319 oai:ojs.acvjournal.com:article/319 |
url |
https://doi.org/10.48750/acv.319 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/319 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/319 https://doi.org/10.48750/acv.319 http://acvjournal.com/index.php/acv/article/view/319/208 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2020 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2020 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 16 No. 3 (2020): September; 191-194 Angiologia e Cirurgia Vascular; Vol. 16 N.º 3 (2020): Setembro; 191-194 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799129849821921280 |