The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Device entrapment during percutaneous coronary intervention of chronic total occlusions: Incidence and management strategies

DOI: 10.4244/EIJ-D-20-00781

1. IRCCS Humanitas Clinical and Research Center, Milan, Itlay, Italy
2. IRCCS Humanitas Clinical and Research Center, Milan, Italy
3. Ospedale San Giovanni Bosco, Turin, Italy
4. Ospedale Niguarda, Milan, Italy
5. Ospedale Maria Vittoria, Turin, Italy
6. Ospedale Maggiore, Lodi, Italy
7. Ospedale Moriggia-Pelascini, Gravedona (Co), Italy

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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.

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