Detachment of a Guidewire Tip as an Intraoperative Complication during Revascularization of Chronic Coronary Artery Occlusion: A Clinical Case

Introduction. Cardiovascular diseases occupy a leading position in the structure of mortality in the world. In particular, coronary heart disease causes mortality in 48% of cases among cardiovascular diseases. Surgical treatment of patients with coronary heart disease is aimed at eliminating stenotic or occlusive lesions in the coronary arteries by heart bypass and/or percutaneous coronary intervention with stenting. The success rate of the procedure accounts for about 85%. In the remaining 15%, revascularization fails to achieve its goal, which may be caused, among other things, by a pronounced calcification of the occlusive segment of the coronary artery. Aim: to demonstrate the development of one of complications after revascularization of chronic coronary artery occlusion and a method for its elimination. Materials and methods. The paper demonstrates a clinical case of an 86­year­old patient with coronary heart disease treated in a non­emergency hospital. Coronary angiography revealed a multivessel lesion. Coronary artery bypass grafting was recommended after an intraoperative consultation with a cardiologist and a vascular surgeon. The next day, the patient underwent emergency coronary angiography in order to revascularize chronic occlusion. Results and discussion. The patient underwent attempted revascularization of chronic calcified occlusion, which resulted in such a complication as deformities and “detachment” of the distal tip of the guidewire. This complication was resolved with the help of a trifold snare and the creative and cold­blooded thinking of the operating surgeon. Conclusion. The clinical case shows that, despite any encouraging statistical success rate, the operating surgeon should be ready for possible intraoperative complications. The key to solving this problem lies in the availability of modern medical tools for coronary interventions, as well as in relevant experience of an operating surgeon and creativity in making certain decisions.

1. Babunashvili A.M., Pancholy S.B. Interosseous artery as an access artery in case of late radial artery occlusion. Catheter Cardiovasc Interv. 2017;90(7):1121–5. DOI: 10.1002/ccd.27106

2. Larionov A.A., Enginoev S.T., Demina E.V., Abugov S.A. Results of recanalization of chronic total occlusions based on hybrid approach. Clinical and Experimental Surgery. Petrovsky Journal. 2022;10(2):70– 80 (In Russ.). DOI: 10.33029/2308-1198-2022-10-2-70-80

3. Assali M., Buda K.G., Megaly M., Hall A.B., Burke M.N., Brilakis E.S. Update on chronic total occlusion percutaneous coronary intervention. Prog Cardiovasc Dis. 2021;69:27–34. DOI: 10.1016/j.pcad.2021.11.004

4. Larionov A.A., Enginoev S.T., Demina E.V., Abdirimov SH.I., Abugov S.A. Comparison of immediate and long-term outcomes of in-stent and native coronary arteries chronic total occlusions. Russian Journal of Endovascular Surgery. 2021;8(4):355–74 (In Russ.). DOI: 10.24183/2409-4080-2021-8-4-355-374

5. Krestyaninov O.V., Khelimskii D.A., Badoian A.G., Ibragimov R.U., Naydenov R.A. Current algorithms for the treatment of chronic coronary total occlusions. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2020;24(2):9–15 (In Russ.). DOI: 10.21688/1681-3472-2020-2-9-15

6. Koelbl C.O., Nedeljkovic Z.S., Jacobs A.K. Coronary chronic total occlusion (CTO): a review. Rev Cardiovasc Med. 2018;19(1):33–9. DOI: 10.31083/j.rcm.2018.01.896

7. Borisov I.A., Shilin D.A., Grigoryan R.F., Zyubin E.A. The use of endovascular hemostasis in the treatment of coronary artery perforation as a complication during recanalization of chronic occlusion. Military Medical Journal. 2023;344(12):64–6 (In Russ.). DOI: 10.52424/00269050_2023_344_12_64

8. Khelimskii D.A., Shermuk A.A., Krestyaninov O.V., Pokushalov E.A., Karaskov A.M. Chronic total coronary occlusion percutaneous intervention. Complex Issues of Cardiovascular Diseases. 2017;(1):58–64 (In Russ.). DOI: 10.17802/2306-1278-2017-1-58-64

9. Choi J.Y., Rha S.W., Choi B.G., Choi S.Y., Byun J.K., Jang W.Y., et al. Percutaneous coronary intervention for chronic total occlusion in single coronary arteries. Tex Heart Inst J. 2021;48(2):e197023. DOI: 10.14503/THIJ-19-7023

10. Stelmashok V., Abramovich M., Mrochek A., Polonetsky O., Kozlovsky V. Predicting successful antegrade recanalization of chronic total occlusions of coronary arteries with coronary wire. Cardiology in Belarus. 2020;12(4):495–506 (In Russ.). DOI: 10.34883/PI.2020.12.4.005

11. Karacsonyi J., Vemmou E., Nikolakopoulos I.D., Ungi I., Rangan B.V., Brilakis E.S. Complications of chronic total occlusion percutaneous coronary intervention. Neth Heart J. 2021;29(1):60–7. DOI: 10.1007/s12471-020-01502-1

12. Khatri J., Abdallah M., Ellis S. Management of coronary chronic total occlusion. Cleve Clin J Med. 2017;84(12 Suppl 3):27–38. DOI: 10.3949/ccjm.84.s3.03

13. Stelmashok V. Risk of cardiac complications in recanalization of chronic total occlusions of coronary arteries with antegrade access. Cardiology in Belarus. 2017;9(4):747–58 (In Russ.).

14. Chevgun S.D., Abdyldaev I.Z., Danyarov B.S., Amatov T.A. Endovascular treatment of chronic total occlusionsof coronary arteries. Vestnik KRSU. 2015;15(7):170–4 (In Russ.).

15. Karacsonyi J., Vemmou E., Nikolakopoulos I., Ungi I., Abi Rafeh N., ElGuindy A. et al. Current challenges and prevention strategies for chronic total occlusion (CTO) complications. Expert Rev Cardiovasc Ther. 2021;19(4):337–47. DOI: 10.1080/14779072.2021.1905521