Perkütan Koroner Girişim Sırasında Kılavuz Tel Kopması Olgusunun Yönetimi
Özet
Perkütan koroner girişim (PKG), akut koroner sendromların tedavisinde yaygın olarak kullanılan güvenli ve etkili bir yöntemdir. Bununla birlikte nadir fakat ciddi komplikasyonlar gelişebilmektedir. Kılavuz tel kopması, oldukça nadir görülen ancak yönetimi zor ve klinik sonuçları önemli olabilen bir komplikasyondur. Bu olgu sunumunda, 68 yaşında erkek hastada ST yükselmesi olmayan miyokard infarktüsü (NSTEMI) nedeniyle yapılan girişim sırasında gelişen koroner içinde kopmuş kılavuz tel (retained guidewire) olgusu ve yönetim süreci sunulmaktadır. Distal sağ koroner arter (RCA) müdahalesi sırasında gelişen kılavuz tel kopmasında koroner snare ile çıkarma ve stent ile “crush” girişimleri başarısız olmuş, işlem sonlandırılmış ve hasta sonrasında koroner arter baypas greftleme (KABG) operasyonuna yönlendirilmiştir. Postoperatif dönemde kardiyojenik şok gelişen hasta kaybedilmiştir. Bu olgu, nadir görülen bu komplikasyonun yönetim zorluklarını ve klinik sonuçlarını ortaya koymaktadır.
Percutaneous coronary intervention (PCI) is a safe and effective method widely used in the treatment of acute coronary syndromes. However, rare but serious complications may occur. Guidewire fracture is an uncommon complication that can be difficult to manage and may have significant clinical consequences. In this case report, we present the management of a retained intracoronary guidewire that occurred during PCI performed for non-ST elevation myocardial infarction (NSTEMI) in a 68-year-old male patient. During intervention of the distal right coronary artery (RCA), guidewire fracture occurred. Attempts to retrieve the fractured guidewire using a coronary snare and stent crush technique were unsuccessful, and the procedure was terminated. The patient was subsequently referred for coronary artery bypass grafting (CABG). However, the patient died due to cardiogenic shock in the postoperative period. This case highlights the management challenges and clinical consequences of this rare complication.
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