Case Report
A 65-year man with type II diabetes and hypertension was referred for elective coronary angiography owing a history of exertional angina and a CT Angiography suggestive of obstructive coronary disease (Calcium score >400 Agatston). Echocardiography displayed mild septum hypertrophy and mild degenerative valve changes without hemodynamic significance. It did not show any segmental kinetic change and an ejection fraction of 65% was calculated by Simpson’s method. The systolic function of the right ventricle was preserved (TAPSE = 22) and no pericardial effusion was present.
Coronary angiography revealed non-significant obstructive disease in the left coronary and two critical lesions in the right coronary artery (RCA): critical stenosis of proximal/medium right coronary and a critical lesion at a bifurcation between distal RCA and posterolateral artery (PLA) (figure 1).
The patient was submitted to a percutaneous coronary intervention of bifurcation lesion through balloon inflation (3,0x15 mm) followed by stent implantation in distal RCA (ONYX 3,5mm x 34 mm) (figure 1). PLA was protected by a guidewire (BMW) and it was made proximal optimization technique (POT) to warrant better stent to vessel apposition. When the operator tried to pull out the PLA guidewire it was trapped between the vessel wall and respective coronary stent. It fractured and its proximal extremity was located at the radial artery. A Microsnare technique was carried out trying to remove it, without success.