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.