Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-118

Stuck Wire in a Calcific Coronary Artery

By Richa Sharma

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Presenter

Richa Sharma

Authors

Richa Sharma¹

Affiliation

Shri Mahant Indiresh Hospital, Dehradun, India¹,

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TCTAP C-118

Coronary - Complication Management

Stuck Wire in a Calcific Coronary Artery

Richa Sharma¹

Shri Mahant Indiresh Hospital, Dehradun, India¹,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

73 year old male , K/C/O CAD/ P/AICD (9monthsback) p/w c/o recent onset rest angina 4 days back in our emergency. K/C/O CAD/ CSA with NYHA class II angina since2-3 years. Past h/o CHB in Jan 2023, for which pt wasimplanted a dual chamber AICD. (EF was low at that time too). CAG was donewhich revealed TVD. Pt was advised for CABG at that time but refused for same.

Relevant Test Results Prior to Catheterization

• Echowas s/o LVEF -30%, mildly dilated LA/LV, mild MR, anterior, anterolateral andinferior wall hypokinetic.Pt wastaken for Check CAG with an intent to revascularize

Relevant Catheterization Findings

• CAG-RCA 99% terminating into 100% CTO• LAD-Prox to mid LAD 99%• LCx-OM-long 80-90% diffuse disease• Allvessels having severe calcium• PLAN-revascularize RCA first f/b LAD with calcium modification therapy : if ballooncrossable- IVL otherwise RA/OA.

Interventional Management

Procedural Step

• FielderFCwith MC support in RCA but wire cudn’t cross the tortous lesion• Dissectionflap was raised which lead to reduction of the flow.• FielderXT was taken but passing in wrong dissection flap, thus reducing flow further Parallel wire technique was tried with fielder FC And XT alternativelybut no successGAIA II wastaken and the nightmare arisesTriedpulling but the wire got unraveled.Tookballoon in the guide and inflated and tried to pull whole assembly together butunraveling continued and stuck part was still inside either the calcium ordissection flapPLAN: takeanother hydrophilic wire distal to stuck wire (Parallel wiring) and inflateballoon to relieve the already stuck wire (Crush wire technique)Fielder FC crossed beyond past the lesion 1.5*15 mm balloon taken and inflated at thesite of stuck wire

Wire got space and came out1.5mm balloon inflated uptill 16atm but itbursted probably bcz of some calcium spur.Check shot- intact flowSequential predilation with 2.5*18mm NC and3.0*12mm NC IVL balloon 3.0*12mm all 8 cycles given.OCT run taken to look for any complications,calcium cracks3.0*28mm DES in mid to distal RCA @ 12atm f/b3.5*38mm DES @12atm from px to mid rca FINAL RESULT- TIMI 3 flowRetrograde collaterals to LAD

Case Summary

The entrapment, fracture anddislodgement of diagnostic or therapeutic devices within the coronarycirculation during a procedure are a rare complication occurring in 0.2–0.8% ofcases. Complex lesions, wire wedginginto distal or winding vessels, wire cutting by means of the atherectomycatheter and structural failure are the main causes of this complication. Some conditions also increase therisk of guide wire rupture, such as hydrophilic wires, attempts in calcifiedand tortuous vessels and jailed GW betweenoverlapping parts of stentsDevicefracture occurs due to entrapment, overcoiling and excessive traction of theguide wire

E-Case

TCTAP C-118