Fracture of an Entrapped Coronary Guidewire During Direct Stenting of a Circumflex Marginal Branch: A Case Report

Guidewire entrapment and fracture during percutaneous coronary intervention (PCI) remain uncommon but challenging complications. Their management depends on fragment location, vessel size, coronary flow, and procedural risk of retrieval. We report the case of a 68-year-old diabetic active smoker admitted for elective PCI after a positive stress echocardiography. Coronary angiography demonstrated balanced coronary circulation with a significant isolated mid obtuse marginal branch stenosis. PCI was performed through left radial access using a BMW guidewire. A direct stenting strategy was selected. During stent deployment, insufficient distal advancement of the guidewire led to wire entrapment within the stent struts. Multiple retrieval attempts using double-wire and balloon-assisted techniques failed. Gentle traction resulted in guidewire fracture, leaving a short radiopaque fragment jailed in a small marginal branch. Repeat angiographic assessment after 48 hours confirmed persistence of the fragment without stent thrombosis or flow limitation. The patient remained clinically stable and asymptomatic. Conservative treatment with dual antiplatelet therapy was continued.