CathLabHub complications toolkitcathlabhub.com/toolkit/wire-fracture-entrapmentIn review, October 24, 2026
Recognize
The signs on the monitor, the image and the patient.
- ImageThe wire does not move with withdrawal, or its tip stays put while the shaft stretches 1.
- ImageA wire tip that no longer responds, or a radiopaque fragment left in the vessel after withdrawal 1.
- ImageAn unraveled coil, a bird's nest of metal, sometimes reaching the aorta 1.
- PatientIschemia if the fragment causes thrombus or obstructs flow.
Act now
In the order the operator does them. The first three come first, whatever else is happening.
- Do not pull hard; pulling unravels or fractures the wire 1.
- Advance a microcatheter or a balloon over the wire as far as possible and pull the wire gently 1.
- If that fails, inflate the balloon advanced as far distally as possible and pull gently again 1.
- If that fails, pass a second wire beside the trapped one and inflate a balloon alongside to free it 1.
- Fractured wire: image with IVUS for unraveling 1.
- Fragments that can be trapped: stent over them against the wall 12.
- Long fragments in a large vessel: remove with wire twirling or a snare 1.
- Small distal fragments: leave in place, with dual antiplatelet therapy 12.
- Unraveled into the aorta or a critical location: surgery 1.
Equipment
From the complications cart. Linked items open in the equipment directory.
- MicrocathetersDirectory: Corsair Pro, Finecross M3.
- Small balloonsDirectory: Trek and Mini Trek.
- Coronary snares2 to 4 mm loops 1.Not in the directory yet.
- Guide extensionDirectory: GuideLiner V3.
- IVUSDirectory: Eagle Eye Platinum.
- Drug eluting stents to trap fragmentsDirectory: Xience Skypoint.
Drugs
Adult doses as the cited source gives them. Check your formulary and the label.
- HeparinTherapeutic ACT during retrieval 3.Weight based dose in the Cath Med App
- Dual antiplatelet therapyWhen a fragment is left in place 2.
Who to call
The escalation ladder, first call first.
- Second operator: to manage the second wire and balloon.
- Cardiac surgery: for an unraveled wire in the left main or the aorta, or a wire that cannot be freed 1.
The bailout step by step
Freeing an entrapped wire 1
- Stop pulling; keep slight tension only.
- Advance a microcatheter or balloon over the trapped wire as far as it will go.
- Hold the microcatheter forward and pull the wire gently through it.
- Still stuck: inflate a balloon at the distal end of the reachable segment and pull gently again.
- Still stuck: pass a second wire beside it, inflate a balloon next to the trapped wire, and try again.
- Still stuck: surgery; a last resort is to pull hard with a balloon or microcatheter in place, accepting a fracture 1.
Prevent
After care and documentation
- Image the final result; document any retained fragment and its location.
- Dual antiplatelet therapy if a fragment stays 2.
- Keep the wire for analysis and report the event through your device reporting process.
Practice
No emergency simulator case for wire fracture or entrapment yet. Browse the case library.
References
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 27, Equipment loss and entrapment.
- Berg R, Lim MJ. Complications of percutaneous coronary interventions. In: Kern MJ, ed. The Interventional Cardiac Catheterization Handbook. 3rd ed. Saunders, Elsevier; 2013. Chapter 4.
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 25, Acute vessel closure.
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 16, Bifurcations.
Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/wire-fracture-entrapment. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.