Discussion
Coronary perforation during or after percutaneous interventions are rare
but potentially life-threatening incidents often resulting in emergency
surgery. While iatrogenic perforations occurred in the catheterization
laboratory may be treated immediately at the site of their occurrence
with several possible techniques, namely through different kinds of
covered stents, rupture of pre-existing coronary pathology frequently is
associated with a possible delayed diagnosis, giving rise to serious
clinical events ( i.e. myocardial infarction, cardiac tamponade, malign
arrhythmias or sudden death). (8)
Though rare, guidewire loss or fracture after PCR can occur. There are
different percutaneous and surgical approaches that try to fix this
possible complication. When percutaneous techniques are not successful,
depending on patient clinical factors and the length of free wire in the
aorta, both surgery or a conservative approach, which includes the
extension of double antiplatelet therapy, are valid. (9, 10) In this
clinical case the risk-to-benefit was considered favorable to a
conservative strategy given the low probability of success of surgery
approach removing trapped guidewire. In order to prevent thrombotic
events, a stent was implanted in PLA to promote endothelization of the
trapped guidewire in the coronary vessel and long-term double
antiplatelet therapy was prescribed.