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.