One, two, three … breakdance and twist

• Published in: Catheterization and cardiovascular interventions Vol. 96; no. 3; pp. 601 - 608
• Main Author: Aranzulla, Tiziana Claudia
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Balloon catheters; Balloon treatment; broken wire; Cardiac Catheters; Catheters; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Device Removal; Equipment Failure; Humans; Implants; Male; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Stents; Treatment Outcome; twin‐twisting wires technique; Wire; wire retrieval; wire retrieval; twin-twisting wires technique; broken wire
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28643

Wire breakage during percutaneous coronary intervention is a rare event. It occurs especially when treating complex lesions, and it should be prevented with careful planning of each procedural step. We reported a case in which wire breakage occurred when treating the left anterior descending (LAD)/first diagonal bifurcation with the T‐stenting technique. After careful evaluation of all the available retrieval techniques and failure of the balloon–catheter trapping, the twin‐twisting wires technique (TTWT) was applied. This technique allows the retrieval of a foreign body thanks to its entrapment in the spiral made by two twisting wires. At the first attempt, the broken wire was only withdrawn and not retrieved, while the two twisting wires went broken. The second attempt was performed using stronger wires as twisting wires. The two recently broken fragments were successfully retrieved together with a long proximal remnant of the initially broken wire, which distal tip was further withdrawn. The broken wire was successfully retrieved with the third attempt, together with the previously implanted LAD stent that was accidentally entrapped in the twist. This is the first report of TTWT implementation for the retrieval of a broken wire from a two‐stent bifurcation, both proximal and distal wire remnants and a total of three broken wires. The improvements we made to the technique, tips and tricks, caveats, and suggestions for successful wire retrieval and avoidance of the complications that we experienced are described in detail.