Author + information
- Received October 10, 2016
- Accepted October 20, 2016
- Published online January 2, 2017.
- Rodrigo Vugman Wainstein, MD, MSc, ScDa,
- Felipe Homem Valle, MDa,
- Fernando Pivatto Júnior, MDb,∗ (, )
- Ivan Morzoletto Pedrollo, MDc,
- Luiz Carlos Corsetti Bergoli, MD, MSca and
- Marco Vugman Wainstein, MD, MSc, ScDa,d
- aCardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- bInternal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- cRadiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- dDepartment of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ↵∗Reprint requests and correspondence:
Dr. Fernando Pivatto Júnior, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, sala 2059, 90.035-903 Porto Alegre–RS, Brazil.
A 66-year-old man with previous coronary artery bypass graft surgery was referred to cardiac catheterization due to a non–ST-segment elevation acute myocardial infarction. On arrival he was hemodynamically stable and complaining of mild chest discomfort. Coronary angiography showed a patent saphenous vein graft (SVG) to distal right coronary artery with severe stenosis in the proximal and midsegment (Figure 1A). The choice for percutaneous coronary intervention was made.
The SVG was cannulated with a JR4 6-F guiding catheter (Launcher, Medtronic, Santa Rosa, California) and a distal protection device (SpyderFX 5.0, Covidien, Mansfield, Massachusetts) was positioned. Three (3.5 mm × 23 mm, 3.5 mm × 38 mm, and 4.0 mm × 28 mm) everolimus drug-eluting stents (XIENCE, Abbott Vascular, Santa Clara, California) were implanted from the distal to the proximal segment of the vessel, respectively (Figure 1B). Stents were post-dilated with a 4.0 mm × 15 mm noncompliant balloon at 18 atm. Subsequent angiographies showed satisfactory result. At filter recovery, entrapment of distal protection device into struts of the more distal stent occurred (Figure 1C). After several unsuccessful attempts to retrieve the filter, an unusual strategy was taken: the device’s 0.014” guidewire was cut at its entry site in the right femoral artery. At the end of the procedure, SVG to distal right coronary artery was occluded proximally. No extravasation of dye was observed in final angiograms. The patient left the laboratory with severe chest pain and 3 mm ST-segment elevation in inferior leads. He was admitted to the coronary care unit and after an uneventful recovery was discharged home 5 days later.
One month after discharge, the patient presented to the emergency department complaining of abdominal discomfort. Surprisingly, it was noted an extrusion of the previously retained guidewire through abdominal wall (Figures 2, 3, and 4, Online Video 1). No signs of infection were observed. Spontaneous and progressive self-extrusion of the guidewire occurred during hospital stay until its complete exit. Patient was finally discharged home 3 days after admission.
For a supplemental video and its legend, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 10, 2016.
- Accepted October 20, 2016.
- American College of Cardiology Foundation