Guidewire coating embolization to the pulmonary artery induced by puncture needle shear injury during cardiac radiofrequency ablation: a case report
Guidewire coating embolization to the pulmonary artery induced by puncture needle shear injury during cardiac radiofrequency ablation: a case report
Publication status: preprint
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Original abstract
Abstract Background Hydrophilic-coated guidewires are essential tools in cardiac interventional procedures. Shear-induced detachment of the hydrophilic coating by a puncture needle represents a rare but potentially serious iatrogenic complication, as dislodged polymer fragments may embolize distally, leading to thrombosis, inflammatory responses, or pulmonary embolism. We present a case of hydrophilic guidewire coating embolization to the pulmonary artery resulting from shear injury by a puncture needle during radiofrequency catheter ablation for a left-sided accessory pathway. Case presentation: A 52-year-old woman with Wolff-Parkinson-White syndrome underwent radiofrequency catheter ablation. During the procedure, the hydrophilic coating of a guidewire was mechanically stripped by an 18-gauge beveled puncture needle. Fluoroscopy raised suspicion of an intravascular foreign body, and intraoperative cone-beam computed tomography (CBCT) precisely localized two thin, loop-like coating fragments, approximately 6 cm and 3 cm in length, within branches of the right inferior pulmonary artery. The three-dimensional spatial information provided by CBCT directly guided the subsequent percutaneous snare retrieval. Both fragments were successfully retrieved via a minimally invasive percutaneous approach using a goose-neck snare. The patient remained asymptomatic throughout the hospital course, with no procedure-related complications, and was discharged on postoperative day 4. At 3-month follow-up, she continued to be symptom-free. Conclusion Percutaneous snare retrieval is an effective intervention for managing hydrophilic guidewire coating embolization to the pulmonary artery. Increased awareness of this complication, avoidance of withdrawing coated guidewires through metallic needles, routine inspection of device integrity, and intraoperative fluoroscopic monitoring are key preventive strategies.