Causes of Fractured Rotational Atherectomy Wire
Rotational atherectomy guidewire fracture occurs primarily due to mechanical stress from guide catheter dislodgement causing wire kinking, advancement of the burr over a kinked or prolapsed wire, or wire entrapment within the atherectomy device itself. 1
Primary Mechanisms of Wire Fracture
Guide Catheter Dislodgement and Wire Kinking
- Loss of coaxial guide catheter alignment during rotational atherectomy causes the guidewire to prolapse and kink within the vessel 1
- Advancing the burr over a kinked wire results in transection of the radiolucent rotational atherectomy guidewire 1
- This mechanism is particularly problematic in ostial lesions where maintaining stable guide catheter position is challenging 1
Excessive Mechanical Stress at Angulated Lesions
- Severe vessel angulation (such as 90-degree exit angles) creates excessive stress on the guidewire during burr advancement 2
- Calcified lesions with sharp angles increase the risk of wire transection, especially when combined with aggressive burr manipulation 2
Wire Entrapment in the Atherectomy Device
- The guidewire can be suctioned into the atherectomy device itself, preventing further advancement and causing wire damage 3
- This mechanism involves the wire being pulled into the rotating mechanism, leading to fracture or severe damage 3
Equipment-Related Factors
- Overtightening of the Y-adapter hemostatic valve can cause fracture of the Teflon sheath housing the drive shaft, though this affects the device rather than the wire directly 4
- Using unfamiliar or inadequately tested hardware increases complication risk in technique-intensive procedures 4
Critical Technical Pitfalls
Inadequate Visualization
- The radiolucent nature of rotational atherectomy guidewires makes damage difficult to detect during the procedure 1
- Operators must maintain heightened vigilance for subtle signs of wire compromise since direct visualization is limited 1
Poor Guide Catheter Support
- Failure to maintain excellent coaxial guide catheter alignment is the most preventable cause of wire fracture 1
- Even brief moments of guide catheter instability during burr advancement can result in wire kinking and subsequent transection 1
Associated Complications
- Wire fracture during rotational atherectomy can lead to vessel wall perforation, requiring emergent pericardiocentesis and bypass surgery 2
- Retained wire fragments necessitate retrieval procedures, which may be complicated by the radiolucency of the wire making standard snaring techniques impossible 5
- Coronary perforation with tamponade represents a life-threatening complication when wire fracture occurs 2