冠状動脈血管内治療中のガイドワイヤー破損に対し外科的摘除および冠状動脈バイパス術を行った1例

Surgical Removal of a Fractured Guide Wire for Coronary Angioplasty and Coronary Artery Bypass Grafting：Report of a Case

はじめに　経皮的冠状動脈形成術（percutaneous coronary intervention：PCI）におけるガイドワイヤーの破損はまれではあるが，いったん発症すれば血栓閉塞や穿孔といった重篤な合併症を引き起こす可能性がある．われわれは，冠状動脈内のガイドワイヤーが抜去不能となり，外科的摘除および冠状動脈バイパス術（CABG）を要した症例を経験したので報告する．

Guide wire fracture is a rare, yet potentially life-threatening complication of percutaneous coronary intervention. A 65-years old man underwent emergent coronary angioplasty for myocardial ischemia. Percutaneous coronary intervention for the residual lesions of left anterior descending artery （LAD） was planned. The protection guide wire for left circumflex artery （LCx） was entangled in the stent in LAD. Despite many attempts, the wire could not be retrieved. Finally, the wire was fractured and the stent in LAD was deformed. The patient was sent to our service to remove the fractured wire. We performed urgent removal of the guide wire and coronary artery bypass grafting （CABG）. The postoperative course was uneventful. The timing of surgical removal of the guide wire and the indication for coronary artery reconstruction should be discussed by heart team.