Floating wire assisted device retrieval-a novel technique for prevention of guide-related coronary injury.

Background: An inward force is experienced by the guide catheter during device retrieval resulting in potential risk of deep engagement into the ostio-proximal coronary segment. This undesired movement can result in coronary injury. There is no systematic data or reports of techniques to prevent such inadvertent guide movement during difficult retrieval of devices.

Methods: In 25 patients undergoing percutaneous coronary intervention, where the conventional methods of guide stabilization failed to prevent deep engagement of guide catheter during device retrieval we used 'floating aortic wire' technique and reattempted retrieval. The primary endpoint was the successful retrieval of the device without deep engagement of the guide.

Results: Successful retrieval was seen without deep engagement of guide in 23(92 %) patients. Left anterior descending(n = 15, 60 %) artery was the most common coronary artery. The XB guide(n = 14, 70 %) was the most commonly used guide for left coronary intervention while Judgkins right and Amplatz left were used most commonly for right coronary intervention. Stent balloon(n = 15, 60 %) was the most common device which required using floating aortic wire for retrieval. Other devices were jailed wire(n = 5,20 %), non-compliant balloon(n = 4,16 %) and cutting balloon(n = 1,4 %). Intravascular ultrasound did not show any guide related vessel injury(dissection or intramural hematoma) in any cases. The floating aortic wire failed to prevent deep engagement in two patients because of longer segment of jailed wire and long stent balloon in distal right coronary artery.

Conclusion: Floating aortic wire assisted retrieval of coronary devices is a simple, reliable and safe technique that prevents deep guide engagement during difficult retrieval.