Abstract：
This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending into the aorta We discuss the technique and step by step approach to the retrieval procedure.
Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires.
Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re-wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires.
Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
摘要：
背景：本文重点介绍了旋转粥样斑块切除术（RARotapro，BostonScientific）用于切割和取回一部分延伸到主动脉中的截留冠状动脉导丝。我们讨论了该技术以及逐步进行取回程序的方法。
方法：四例中的三例描述了在右冠状动脉（RCA）中的导丝截留，一条通过逆行途径位于左前降支动脉。在所有情况下，导丝在冠状动脉内段内都是完整的。在案例1中，在慢性完全闭塞（CTO）经皮冠状动脉介入治疗期间，导丝（Runthrough;Terumo）被截留在急性边缘分支中。在案例2中,在通过支架支柱重新布线右后外侧支期间,夹住了一根耳语丝(Abbott)。钢丝牵引导致远端和近端支架严重畸形,需要进行第二阶段手术以完成RCACTO的血运重建.在病例3中,穿通线被夹在两层支架之间,并且在近端处断裂,细丝延伸到降主动脉中。在案例4中，通过在导线的远端尖端打结，通过隐静脉移植物连接将Pilot200（Abbott）导线逆行截留在内膜下间隙。在所有四种情况下，RA均用于成功切割和移除夹带的导丝。
结论：当常规策略失败时，旋转消融技术似乎是一种安全有效的冠状动脉导丝截留治疗策略。
方法：四例中的三例描述了在右冠状动脉（RCA）中的导丝截留，一条通过逆行途径位于左前降支动脉。在所有情况下，导丝在冠状动脉内段内都是完整的。在案例1中，在慢性完全闭塞（CTO）经皮冠状动脉介入治疗期间，导丝（Runthrough;Terumo）被截留在急性边缘分支中。在案例2中,在通过支架支柱重新布线右后外侧支期间,夹住了一根耳语丝(Abbott)。钢丝牵引导致远端和近端支架严重畸形,需要进行第二阶段手术以完成RCACTO的血运重建.在病例3中,穿通线被夹在两层支架之间,并且在近端处断裂,细丝延伸到降主动脉中。在案例4中，通过在导线的远端尖端打结，通过隐静脉移植物连接将Pilot200（Abbott）导线逆行截留在内膜下间隙。在所有四种情况下，RA均用于成功切割和移除夹带的导丝。
结论：当常规策略失败时，旋转消融技术似乎是一种安全有效的冠状动脉导丝截留治疗策略。
