Successful Removal of a Fractured Guidewire During Percutaneous Coronary Intervention With Orbital Atherectomy

Harish Ravipati; Edo Kaluski

doi:10.1016/j.jaccas.2026.109241

Successful Removal of a Fractured Guidewire During Percutaneous Coronary Intervention With Orbital Atherectomy

JACC Case Rep. 2026 Jul 9:109241. doi: 10.1016/j.jaccas.2026.109241. Online ahead of print.

Authors

Harish Ravipati¹, Edo Kaluski²

Affiliations

¹ Guthrie Cortland Medical Center, Cortland, New York, USA. Electronic address: drharishravipati@gmail.com.
² Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA.

PMID: 42423570
DOI: 10.1016/j.jaccas.2026.109241

Abstract

Background: Guidewire entrapment or fracture is a rare complication during percutaneous coronary intervention (PCI). Timely management is warranted to prevent poor cardiac outcomes.

Case summary: An 83-year-old man with coronary artery disease was referred for PCI given severe left anterior descending disease and right coronary artery disease (RCA). During PCI of in-stent restenosis of the RCA, the 0.014-inch Versaturn guidewire (Abbott) was entrapped in the coronary calcium within a prior stent, and the tip fractured. The wire entrapment led to a technically complex procedure, which was treated with orbital atherectomy and stenting of the RCA to cover the entrapped fractured wire.

Discussion: Previous reports have highlighted the use of rotational atherectomy in coronary artery remodeling and the management of entrapped or fractured guidewires. This is the first reported case employing orbital atherectomy to manage an entrapped fractured guidewire within calcific in-stent restenosis.

Take-home message: Guidewire entrapment within critical calcific lesions creates considerable difficulty, which can lead to cardiac complications, and it can be managed with orbital atherectomy and stenting.

Keywords: coronary angiography; left-sided catheterization; percutaneous coronary intervention.

Publication types

Case Reports