• Zi-Wei Zhang, Xiao-Juan Pan, Ji-Hong Zou, and Feng Qi.
• Department of center for coronary heart disease, Fu Wai Yunan Cardiovascular Hospital, Kunming, China.
• Medicine (Baltimore). 2024 Apr 19; 103 (16): e37842e37842.

RationaleGuidewire fracture is one of the biggest risks of percutaneous coronary intervention, twisting wire technique is very useful for retrieving the fractured wire, but the potential risks have been inadequately reported. Herein, we present a case of retrieval of guidewire fragments using the twisting wire technique that causes coronary perfusion.Patient ConcernsA 37-year-old male patient was admitted to our hospital for elective percutaneous coronary intervention of the left circumflex coronary artery.Clinical FindingsFor chronic total occlusion of the distal left circumflex coronary artery, antegrade recanalization by wire escalation, and parallel wire techniques were attempted. However, we shockingly found that the BMW guidewire, anchored in the right coronary artery, spontaneously fractured from the proximal right coronary artery, and a lengthy fragment of the guidewire remained in the coronary.Diagnoses, Interventions, And OutcomesMany attempts were made to retrieve the remnant guidewire including the twisting wire technique, which leads to the perforation of the coronary.OutcomesFinally, percutaneous retrieving procedures were stopped in favor of surgical extraction via a small coronary arteriotomy. This procedure was successful.LessonsTo the best of our knowledge, the present case is the first reported spontaneous fracture of the guidewire. Leaving such a lengthy remnant guidewire in the artery, or leaving stenting over the wire, would impose a high risk of coronary thrombosis, perforation, and embolization. Yet, the perforation of the artery that occurred in this case, which could have had life-threatening consequences, resulted from our attempts to retrieve the guidewire using the twisting wire technique.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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