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The patient considers himself ill since February 2021, when he was first disturbed by pressure pains behind the sternum.  EchoCG findings: Cardiac chambers are not dilated. Myocardial hypertrophy of the left ventricle, RV 65%.  No impairment of local contractility was revealed. Due to progressive deterioration of his health and ineffectiveness of the outpatient therapy, the patient came to our hospital

Clinical bloodtest: RBC – 4.7 10 in 12 tbsp. / l; HGB - 160 g / l;  MCV – 98,9  cubic meters; PLT - 241 10 in 9 st. / l; MPV –9.1 cubic meters; Leukocytes – 6.6 10 in 9 tbsp. / l; Segmented neutrophils,% -72.9%; Lymphocytes,% - 22%; Monocytes,% - 4.5%; Eosinophils,% - .03%;Basophils,% - 0.3%; Erythrocyte sedimentation rate - 12 mm / h;Biochemicalblood test: Potassium – 3.37 mmol / l; Glucose – 10.9 mmol / L; GFR (MDRD) M – 62,38ml / min / 1.73m2; Serum creatinine – 111 μmol / l.

Type of coronaryblood supply: balanced..LM: 90% stenoticin the terminal section.LAD: has uneven contours throughout.CxA: ): has uneven contours throughout. The OM-2  is occluded in the proximal third, thepost-occlusion sections are well filled along the intrasystemic collaterals.RCA: has uneven contours, 80% stenosis inthe middle segment. The PDA has uneven contours throughout, 75% stenosis in themiddle third.

A guiding catheter was placed in the ostium of the LM. A coronary guidewire was inserted through the stenosed area into the distal LAD bed. The  second coronary guidewire was inserted through the stenosed sectioninto the distal CxA bed. Balloon catheters 2.0-10 mm, 2.5-10 mm and 3.0-20 mm were used for predilation in the affected area of the LM and LAD. DES 3.5-30 mm was implanted into the LM with the transition to the proximal  segment of the LAD under pressure of 14 atm. During coronary guidewire grafting through the stent cell in the CxA, fragmentation of the radiographically contrast tip of the guidewire in theproximal segment of the CxA was observed. A decision was made to cover the torn conductor tip with a stent. The coronary guidewire was replaced and inserted into the distal CxA bed. Balloon catheters 3.5x15 mm and 3.5x15 mm were used for postdilatation of the stented section of the LM, LAD, and CxA using the "kissing balloons" method. The Guideliner catheter was used to guide and implant a DES 3.5-34 mm into the proximal and distal segments of the CxA with anexit into the LM at 14 atm. Coronary guidewire were rewired. 3.5x15mm and 3.5x15 mm balloon catheters were used to postdilate the stented sectionsof the LM, LAD, and CxA by "kissing balloons"method. POT of the stented section of LM was performed using a 5.0x10 mm balloon catheter. The control angiography showed the blood flow along the TIMI III arteries. Theoperation was completed.

Fragmentationof the guidewire is a rather rare complication of coronary stenting, but it isworth remembering the methods of its treatment. Knowledge of the methods oftreatment of complications helps the operator to choose the most appropriatemethod of treatment and achieve the optimal result of stenting.