Aims: To describe the incidence, procedural characteristics and discuss management strategies of device entrapment in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
Methods and results: Device entrapment was characterized in a large consecutive series of 2361 CTO PCI cases performed by five high-volume CTO Italian operators between January 2015 and January 2020. Device entrapment occurred in 36 out of 2361 cases (1.5%) and consisted of coronary guidewires in 13 (0.5%), microcatheters in 6 (0.2%), balloons in 6 (0.2%), rotational atherectomy burrs in 10 (0.4%) and guiding catheter extension in 1 patient (0.04%). Complete device retrieval was achieved in 63.9%, with at least partial removal of material in 97.2%. Vessel recanalization was still possible in 86.1% of cases even after device entrapment. Intraprocedural myocardial infarction occurred in 3 patients (8.3%); tamponade with urgent pericardiocentesis in one (2.8%) and emergency surgical removal of the entrapped device in one patient (2.8%). Mean radiation dose was 4.7±2.3 Gy. At 30-day follow-up, one patient died with stent thrombosis of a non-target vessel and another required repeat percutaneous revascularization.
Conclusions: Device entrapment during CTO revascularizations is a rare but potentially severe complication. We describe and discuss current techniques of percutaneous retrieval that can be employed to safely achieve procedural success.