Device entrapment during percutaneous coronary intervention

Abstract

Introduction: Device entrapment is a life-threatening complication during percutaneous coronary intervention (PCI). However, the success for its management is predominantly based on operator experience with limited available guidance in the published literature.

Methods: A systematic review was performed on December 2021; we searched PubMed for articles on device entrapment during PCI. In addition, backward snowballing (i.e., review of references from identified articles and pertinent reviews) was employed.

Results: A total of 4209 articles were retrieved, of which 150 studies were included in the synthesis of the data. A methodical algorithmic approach to prevention and management of device entrapment can help to optimize outcomes. The recommended sequence of steps are as follows: (a) pulling, (b) trapping, (c) snaring, (d) plaque modification, (e) telescoping, and (f) surgery.

Conclusions: In-depth knowledge of the techniques and necessary tools can help optimize the likelihood of successful equipment retrieval and minimization of complications.

Keywords: PCI; complications; coronary artery disease; percutaneous coronary intervention.

Figure 1

(A) Obtuse marginal chronic total occlusion (CTO) filled from epicardial collateral channels originating from the RCA; (B) retrograde guidewire entrapment into the epicardial branch (white arrow); (C) guidewire controlled rupture by simultaneous microcatheter pushing and guidewire pulling (white arrow); (D) successful retrograde wiring of a different collateral channel; (E) advancement of a retrograde microcatheter into the distal target vessel; (F) final angiographic result. RCA, right coronary artery

Figure 2

(A) Calcified RCA chronic total occlusion (CTO); (B) guidewire entrapment into the CTO body (white arrow); (C) unsuccessful trapping technique into the guiding catheter (white arrow); (D) a micro loop snare was advanced over the entrapped guidewire and tightened (white arrow); (E) the entire system (snare and guiding catheter) was pulled back (white arrow); (F) successful rupture of the distal segment of the wire that was left into the vessel architecture (white arrow); (G) final result after successful RCA CTO recanalization RCA, right coronary artery

Figure 3

The distal tip of a jailed circumflex guidewire became entangled with the left main stent, forming a knot. Multiple retrieval attempts failed and the distal spring coil created a metal “bird's nest” (white arrow) that needed surgical wire retrieval followed by coronary artery bypass graft. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

(A) Calcified RCA chronic total occlusion (CTO); (B) an antegrade Caravel microcatheter (white arrow) was forced into the calcified CTO body; (C) Caravel microcatheter tip fracture (white arrow); (D) successful retrieval of the tip fragment by pulling the entire system. RCA, right coronary artery

Figure 5

(A) Caravel microcatheter tip fracture (white arrow); (B) balloon inflation over the same guidewire to free the tip (white arrow); (C) guidewire advancement (white arrow) and balloon inflation around the fractured tip; (D) the fractured tip (white arrow) was left into the occluded vessel and the procedure was then aborted

Figure 6

(A) Original LAD angiogram; (B) broken Corsair tip in LAD; (C) low‐profile (1.2 mm) balloon angioplasty around the entrapped device (white arrow); (D) removal with the balloon. LAD, left descending anterior artery.

Figure 7

Microcatheter tip fracture during RCA percutaneous coronary intervention (PCI) managed with laser atherectomy. (A) Reattempt PCI of calcified RCA subocclusion (yellow arrowheads); (B) microcatheter tip fracture (red arrow) after successful wiring; (C) guide extension‐assisted high‐energy excimer laser passes (80 mJ/mm², 80 Hz; green arrowhead); (D) successful mobilization of the microcatheter tip (green arrowhead); (E) embolized microcatheter tip (red circle); (F, G) additional lesion preparation with rotational atherectomy due to balloon uncrossable lesion; (H) stable distal vessel perforation treated conservatively; (I, J) stenting and final angiographic result. RCA, right coronary artery. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 8

(A) A 1.25 mm burr entrapment (white arrow) into LAD; (B) balloon inflation (white arrow) around the entrapped burr; (C) successful withdrawal of the entire system (white arrow). LAD, left descending anterior artery.