It was reported that wire breakage occurred.The 50% stenosed lesion was located in the moderately tortuous mid right coronary artery (rca).A comet pressure was selected and shaping was performed.Ffr was performed in the lesion with the pressure wire.When the device was advanced to the peripheral, pd pressure was not displayed.Detachment of approximately 12 cm of the comet wire occurred.The procedure with comet was performed with a younger physician and when the separation occurred, another physician attempted bailout.The physician attempted to retrieve the fragment via snare however, there was difficulty crossing and the retrieval attempt was unsuccessful.A 6fr guide catheter was used.There was difficulty engaging the guide catheter due to the vessel anatomy.The guide catheter disengaged during bailout attempts.The distal portion of the separated part was trapped in a small vessel and the proximal portion of the separated part did not remain in the guide catheter.The patient was sedated halfway during the procedure due to the prolonged procedure time.The total procedure time was 6 hr 30min.Retrieval attempts were discontinued and the patient was sent to the icu.The next day, surgery was performed to remove the wire fragment.Surgery then continued for bypass surgery.
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It was reported that wire breakage occurred.The 50% stenosed lesion was located in the moderately tortuous mid right coronary artery (rca).A comet pressure was selected and shaping was performed.Ffr was performed in the lesion with the pressure wire.When the device was advanced to the peripheral, pd pressure was not displayed.Detachment of approximately 12 cm of the comet wire occurred.The procedure with comet was performed with a younger physician and when the separation occurred, another physician attempted bailout.The physician attempted to retrieve the fragment via snare however, there was difficulty crossing and the retrieval attempt was unsuccessful.A 6fr guide catheter was used.There was difficulty engaging the guide catheter due to the vessel anatomy.The guide catheter disengaged during bailout attempts.The distal portion of the separated part was trapped in a small vessel and the proximal portion of the separated part did not remain in the guide catheter.The patient was sedated halfway during the procedure due to the prolonged procedure time.The total procedure time was 6 hr 30min.Retrieval attempts were discontinued and the patient was sent to the icu.The next day, surgery was performed to remove the wire fragment.Surgery then continued for bypass surgery.
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It was further reported that the lesion was 75% stenosed, not 50% as previously reported.The lesion was in the proximal to mid right coronary artery (rca), not the mid rca as previously reported.The comet wire was advanced to the coronary artery, 4 pd.The distal part of the coment went into a small branch; therefore, the comet wire was removed outside the body.The shape of the distal part of the comet was changed and the comet was inserted again into the coronary artery.During handling of the comet, manipulation at the proximal part of the comet was not delivered to the distal part of the comet which was located in coronary artery, therefore, the comet was removed outside the body and it was confirmed that the distal part of the comet got detached.Angiography was performed and it was noted that the detached part of the comet was left in the coronary artery.It was considered that the detached part of the comet remained in the valsalva sinus from the procedure process and angiography result.Transcatheter removal of the detached part of the comet was attempted.It was difficult to catch the detached part of the comet by using snare, and another attempt by wire twist was performed but it was unsuccessful.It was attempted to change the placement of the distal wire by using the resistance of an inflated balloon within a stent, but it was unsuccessful.Keeping a guide catheter engagement coaxially was difficult due to the anomalous of the origin of right coronary artery (right coronary was originated from front).And another approach from the femoral artery was obtained.By using double guide system, removal for the detached part of the comet with a snare catheter was attempted, but it was hard to remove the detached part of the comet.By using a multifunction catheter, guidewire, guideliner and etc, it was attempted to change the wire position but it was difficult to do it.Coronary angiography was performed, it was suspected that the detached part did not remain in the valsalva sinus, and ivus was performed.With the analysis of ivus image and perspective image, distal end of the detached part was located in a small side branch at proximal to the 4pd, and the proximal of the detached part was located in a side branch at proximal rca.It was considered that transcatheter removal of the detached part was not only difficult but it could also have a risk to cause coronary perforation, then it was decided to close the procedure.Thoracotomy was performed to remove the detached part of the comet from 4pd.
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