Use of a coronary guidewire to facilitate transseptal puncture: A randomized comparison with a conventional technique.

INTRODUCTION: Transseptal puncture (TSP) is routinely performed for left heart intervention, but it can sometimes be complex and life-threatening. This study introduced a safe and effective method to facilitate TSP for left atrial access. METHODS AND RESULTS: A total of 200 patients (190 with atrial fibrillation, 10 with a left accessory pathway) were prospectively analyzed. In the guidewire group, TSP was performed using a SWARTZ sheath and a Brockenbrough needle with a 0.014-inch coronary guidewire instead of an inner stylet. The needle tip position was confirmed by pushing the guidewire into the left superior pulmonary vein after initial puncture in 100 patients. In the contrast group, TSP was performed in 100 patients using standard devices by injecting contrast to confirm needle-tip position. Left atrial access was achieved successfully in all patients in the two groups without serious complications. The guidewire group showed a higher first-pass rate for left atrial access compared with the contrast group (81.1% vs. 75% p < .001, respectively). CONCLUSION: Coronary guidewire TSP is safe and is associated with a high success rate, and it is thus a useful alternative to conventional TSP. This method is useful for patients with septal aneurysms and contrast allergies.

A missing coronary guidewire mimicking aortic dissection-a case report.

Background: A retained coronary guidewire following coronary angiography is an extremely rare complication. We present a case of a retained coronary guidewire from a percutaneous coronary intervention done 2 years ago. Case summary: An 80-year-old asymptomatic man with a history of ischemic heart disease and moderate aortic stenosis presented to the echocardiography lab for routine follow-up. Transthoracic echocardiography showed Moderate aortic stenosis and a suspected linear echogenic structure in the ascending aorta. trans-esophageal echocardiography was performed to reveal a mobile and linear echogenic structure originating from the sinuses of Valsalva/Sinotubular junction and extending to the ascending aorta. An electrocardiogram gated cardiac computed tomography was performed and showed A linear well-defined structure originating from the ostium of the left main coronary artery and extending to the ascending aorta-a coronary guidewire from an earlier procedure. A second look at the last invasive coronary angiography record demonstrated the same finding. A multidisciplinary heart team discussion was obtained and concluded that the risk of surgical or endovascular intervention outweighed the potential benefit. The patient was discharged home for a close clinical and echocardiographic follow-up. Discussion: A retained coronary guidewire is a rare complication that operators should be aware of. Management should be case-specific depending on clinical presentation.

Umbilical catheter placement aided by coronary guidewires.

Catheterization of the umbilical vessels has proven to be an effective and relatively rapid method for gaining central vascular access in neonates. However, it can be technically difficult, the procedure may last 30 min or longer, and it can be associated with complications in some patients. We suggest using a coronary guidewire during catheterization of umbilical vessels to support the placement of umbilical catheters and significantly reduce a risk for complications. We tested the proposed technique in 6 successful ex vivo bench tests of catheterization of the umbilical vessels in stillborn piglets immediately after birth. We are confident that using coronary guidewire as a guiding tool during catheterization of the umbilical vessels is a rapid and safe method. We expect that it allows to obtain a vascular access with lower risk for dangerous procedural complications, which could be a lifesaving in critically ill patients. However, the approach needs to be validated in a comparative study in neonates.

Percutaneous Transluminal Angioplasty in Chronic Total Subclavian Venous Stenosis Using Coronary Guidewire: A Case Report.

Arteriovenous fistula is the best permanent vascular access for hemodialysis (HD). However, in our country, HD catheter in jugular or subclavian vein is more commonly found because our patients prefer to hold HD until the complications are unbearable. The catheter increases risk of venous stenosis on site and in surrounding vessels, resulting in access loss. Percutaneous transluminal angioplasty (PTA), combined with stent deployment, can be utilized as main treatment for such stenosis in subclavian vein. This method dated back to two decades ago with high success rate. Nevertheless, reports or studies of angioplasty in total occlusion are scarce, mainly because of lower success rate and the need of smaller penetrating wire. We describe our experience in performing PTA and stent deployment using coronary wire to penetrate total occlusion in subclavian venous stenosis after vein cannulation. We hope that we can give an alternative technique to avoid surgery in such cases.

Snaring Technique for Removal of Entrapped Coronary Guidewire in the Left Anterior Descending Artery.

A 68-year-old female underwent coronary angiogram which was complicated by guidewire entrapment in a deployed left anterior descending (LAD) artery stent that extended into the aorta. Snare loop technique was utilized to retrieve the entrapped guidewire and LAD stent with successful deployment of a new stent. Snaring technique is a unique method for percutaneous extraction and can be utilized with whole stent removal along with the guidewire. This technique, as outlined in our case, can be a safe and effective approach.

Modes of failure with fractional flow reserve guidewires: Insights from the manufacturer and user facility device experience database.

BACKGROUND: Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. AIM: To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for commonly used FFR guidewires. METHODS: The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires [PressureWireTM X (Abbott), CometTM (Boston Scientific), and VerrataTM (Philips)] by searching for the following events: "Injury", "malfunction", "death", and "other". This yielded 544 reports. After excluding incomplete reports, 486 reports were analyzed. RESULTS: Guidewire tip fracture was the most commonly reported mode of failure, in 174 (35.8%) cases followed by guidewire kinking (n = 152, 31.3%), communication failure (n = 141, 29.0%), and shaft fracture (n = 67, 13.8%). In total, 133 (27.4%) device failures resulted in patient adverse events. The most common adverse event was retained guidewire tip, in 71 (53.4%) cases, followed by freshly deployed stent dislodgment (n = 26, 19.6%) and coronary artery dissection (n = 23, 17.3%). Seven deaths were reported. CONCLUSION: FFR guidewire failures can occur because of various mechanisms and cause patient adverse events. The MAUDE database serves as an important platform for improved collaboration among clinicians, device manufacturers, and regulators to improve device performance and optimize patient outcomes. Our analysis provides mechanistic insights of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.

Coronary Guidewire Fracture Into a Radial Artery Loop: A New Complication in the Transradial Era?

To date, complete fracture of a coronary wire into a radial artery loop has never been reported. We describe the occurrence of a new complication in the transradial intervention era.

Coronary angioplasty in spontaneous coronary artery dissection-Strategy and outcomes.

OBJECTIVE: To study the clinical, angiographic and technical characteristics of patients with spontaneous coronary artery dissection (SCAD) undergoing percutaneous coronary intervention (PCI). METHODS: This was a retrospective single center study where patients with angiographically confirmed SCAD undergoing PCI over a period of 4 years (2013-2017) were analyzed. We also sought to identify the clinical and angiographic predictors of procedural failure during PCI. RESULTS: There were a total of 42 patients with angiographically confirmed SCAD during the study period of which 16 patients (38.1%) underwent PCI. 14 out of the 16 patients (87.5%) taken up for PCI had technical success. In all patients the lesion was initially attempted to cross with a floppy wire and if unsuccessful it was escalated to a hydrophilic wire and finally to a stiff wire The SCAD lesion was crossed with a floppy wire in 71.4% of patients, with a hydrophilic wire in 14.2% and a stiff wire in 7.1% of patients. Wire escalation was required in 5 patients (31.3%) and in 60% of cases there was a technical success after wire escalation. Presence of diabetes mellitus, hypertension, dyslipidemia, smoking, coexisting atherosclerosis, diffuse nature of the lesion, and baseline Thrombolysis in Myocardial Infarction (TIMI)≤2 flow did not predict procedural failure during PCI. CONCLUSION: PCI in SCAD is associated with a fair rate of technical success in our population. Choosing an initial floppy wire and then escalating to a hydrophilic wire followed by a stiff wire is an optimal revascularization strategy.

Central perforation of atretic pulmonary valve using coronary microcatheter.

Percutaneous perforation of pulmonary valve, using 0.014" guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.