Dataset Information

A missing coronary guidewire mimicking aortic dissection-a case report.

ABSTRACT:

Background

A retained coronary guidewire following coronary angiography is an extremely rare complication. We present a case of a retained coronary guidewire from a percutaneous coronary intervention done 2 years ago.

Case summary

An 80-year-old asymptomatic man with a history of ischemic heart disease and moderate aortic stenosis presented to the echocardiography lab for routine follow-up. Transthoracic echocardiography showed Moderate aortic stenosis and a suspected linear echogenic structure in the ascending aorta. trans-esophageal echocardiography was performed to reveal a mobile and linear echogenic structure originating from the sinuses of Valsalva/Sinotubular junction and extending to the ascending aorta. An electrocardiogram gated cardiac computed tomography was performed and showed A linear well-defined structure originating from the ostium of the left main coronary artery and extending to the ascending aorta-a coronary guidewire from an earlier procedure. A second look at the last invasive coronary angiography record demonstrated the same finding. A multidisciplinary heart team discussion was obtained and concluded that the risk of surgical or endovascular intervention outweighed the potential benefit. The patient was discharged home for a close clinical and echocardiographic follow-up.

Discussion

A retained coronary guidewire is a rare complication that operators should be aware of. Management should be case-specific depending on clinical presentation.

SUBMITTER: Arow Z

PROVIDER: S-EPMC10977952 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

A missing coronary guidewire mimicking aortic dissection-a case report.

Arow Ziad Z Bar Sef Avigdor A Assali Abid A Arnson Yoav Y

European heart journal. Case reports 20240220 4

<h4>Background</h4>A retained coronary guidewire following coronary angiography is an extremely rare complication. We present a case of a retained coronary guidewire from a percutaneous coronary intervention done 2 years ago.<h4>Case summary</h4>An 80-year-old asymptomatic man with a history of ischemic heart disease and moderate aortic stenosis presented to the echocardiography lab for routine follow-up. Transthoracic echocardiography showed Moderate aortic stenosis and a suspected linear echog ...[more]

PMID: 38560489

Similar Datasets

Project description:Introduction and importanceVarious artifacts mimicked aortic dissection, such as streak artifacts generated by high-attenuation material, high-contrast interfaces, cardiac motion, periaortic structures, aortic wall motion, and normal aortic sinuses, have been described in the literature. Most artifacts that simulate ascending aortic dissection occur frequently on conventional CT. Their position is predictable and is related to systolic aortic motion. However, so far, to the best of our knowledge, this is the first pseudo-aortic dissection reported during coronary angiography in cardiac arrest.Case presentationWe report a case of a middle-aged man transferred to our hospital after an out-of-hospital cardiac arrest. The coronary angiography revealed non-obstructive coronary arteries and an image of probable aortic dissection was observed. Given the persistent asystole despite a prolonged advance cardiopulmonary resuscitation and the possibility of aortic dissection, a prompt in-room heart team discussion was performed. It was decided to stop and withdraw potentially life-sustaining treatment due to futility. The necropsy study revealed the aorta with some mild atherosclerotic plaques but without either aneurysm or thrombosis. The coronary arteries were reported as with patency, but in the proximal left anterior descending artery (LAD), the intima layer presented a thickness that decreased 50 % of the luminal area without signs of complicated acute plaques.Clinical discussionIn this case, the systolic aortic motion theory cannot explain the false-aortic dissection image in the coronary angiography because the patient was under cardiac arrest. Studies with arterial and venous pressures devices recording in cardiac arrest, demonstrated an abnormal hemodynamic flow, suggesting that the hemodynamic flow might be backward during cardiopulmonary resuscitation Therefore, in the setting of this abnormal hemodynamic flow, the injection of contrast may have an abnormal distribution and flow in the aorta creating an image of pseudo-aortic dissection.ConclusionAlthough the exact mechanism of this false-positive aortic dissection in cardiac arrest remains unknown, operators should be aware of this entity during coronary angiography in the setting of cardiac arrest with mechanical chest compressions to avoid diagnostic errors in clinical practice.

Dataset Information

A missing coronary guidewire mimicking aortic dissection-a case report.

Background

Case summary

Discussion

Publications

A missing coronary guidewire mimicking aortic dissection-a case report.

Similar Datasets

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