Device entrapment during percutaneous coronary intervention

Sánchez, Jorge Sanz; Mashayekhi, Kambis; Agostoni, Pierfrancesco; Egred, Mohaned; Avran, Alexandre; Kalyanasundaram, Arun; Garbo, Roberto; Colombo, Antonio; Regazzoli, Damiano; Reimers, Bernhard; Brilakis, Emmanouil S.; Gasparini, Gabriele L.

doi:10.1002/ccd.30160

Cited by 12 publications

(5 citation statements)

References 36 publications

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“…Various management modalities have been introduced as bailout strategies in case of device entrapment in the coronaries, such as snaring, pulling, and telescoping techniques. In a systemic literature review [6], it was alleged that efforts to avoid surgical intervention should be maximized as the outcome might be inferior to other strategies due to the lack of expertise to deal with such a rare incident. The surgery in this patient was completed successfully, and the patient could be discharged with retained myocardial functions.…”

Section: Discussionmentioning

confidence: 99%

The lost balloon at midnight: a case report reveals the inevitability of heart team existence

Elbayomi

Weyand

Nooh

et al. 2023

J Cardiothorac Surg

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Background Dislodgement of a coronary stent-balloon catheter during percutaneous coronary intervention (PCI) is rare but is a life-threatening complication. Case summary A 57- year-old male presented with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography revealed total thrombotic occlusion of the Right coronary artery (RCA). Following the balloon dilatation of the RCA and while trying to retrieve the balloon catheter, the balloon was dislodged from the catheter shaft and entrapped in the coronary vessel. Under cardiopulmonary bypass, with antegrade cardioplegic arrest, the balloon was extracted through a coronary arteriotomy. Right coronary revascularization was done with reversed saphenous vein graft (SVG). Discussion Given the variety of equipment that can be retained in the coronary artery and the multitude of mechanisms by which it may be entrapped, there are no straightforward techniques applicable to all situations. Specific guidelines or recommendations on properly managing these potentially life-threatening complications do not exist. However, the most crucial issue in the management of these cases is the hemodynamic status of the patient as well as the coronary flow in the vessel with entrapped device or stent. In our case, the RCA was retrogradely perfused from the left coronary artery, which provided time to transfer the patient to cardiovascular surgical backup.

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Section: Discussionmentioning

confidence: 99%

The lost balloon at midnight: a case report reveals the inevitability of heart team existence

Elbayomi

Weyand

Nooh

et al. 2023

J Cardiothorac Surg

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“…Complete device retrieval is achieved in 63.9% [5], the recommended sequence of steps to manage this entrapment are: pulling, trapping, snaring, plaque modi ication, telescoping, and surgery [6].…”

Section: Abbreviationsmentioning

confidence: 99%

How to manage balloon entrapment during percutaneous coronary intervention of a calcified lesion “Case report”

Nassime¹,

Amina²,

Nadhir³

et al. 2022

J Cardiol Cardiovasc Med

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Percutaneous coronary angioplasty is a minimally invasive procedure aimed at unclogging a coronary artery with a low complication rate (with a serious complication rate of 3% to 7% and a mortality rate of 1.2%). Device entrapment during PCI is a rare but life-threatening complication that occurs in < 1% of PCIs and balloon entrapment comes second after coronary guidewires. We present the case of 68-years-old man, smoker, hypertensive and type2 diabetic that presents angina with evidence of ischemia on myocardial tomoscintigraphy and in whom the radial coronary angiography reveals a tight calcified mid LAD stenosis. During his PCI and after dilatation with an NC balloon 2.5 × 12 the latter refuses to deflate and remains trapped in the lesion with the appearance of pain and ST-elevation despite several attempts to dilute the product in the inflator and to burst it by overexpansion. Traction on the balloon resulted in the deep intubation of the guiding-catheter, which comes in contact with the trapped balloon, and the rupture of the latter’s hypotube, which remains inflated at the site of the lesion and mounted on the 0.014 guidewire. We put a second 0.014 guidewire distally in the LAD and twisted with the distal part of the first guidewire, then we introduced a second balloon 2.0 × 20 over the second guidewire until the distal part of the guiding-catheter and inflated to trap the stucked balloon. We gradually removed this emergency assembly that allowed us to retrieve the trapped balloon. The control injection revealed a thrombotic occlusion of the LAD treated by thrombectomy and anti-GPIIbIIIa followed by a DES 2.75 × 28 placement. The patient was discharged 48 hours later with a good LVEF. The possible balloon entrapment mechanisms are an acute recoil of a highly calcified lesion with compression of the incompletely deflated balloon, which seems to be the case in our patient, strangulation of the proximal balloon end by the guiding-catheter if the balloon is removed before complete deflation and break or bend of the hypotube. The solutions in case of undeflatable balloon entrapment are to dilute the product in the inflator, to burst it by overexpansion, to pierce it through a stiff guidewire (or through its other end on a Microcatheter or OTW balloon), to cut its outer part and let it empty passively, to introduce a second guide-wire and perform a Buddy-Balloon or to transfer the patient to Surgery. Material entrapment remains a rare but life-threatening complication, its eviction requires the choice of material size and gentle manipulations (small balloons in the event of a calcified lesion) and its management uses different techniques, the choice of which depends on the clinical and anatomical situation.

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“…The prognosis of PCI is uncertain. Recurrent angina pectoris, chest pain, and acute myocardial infarction can lead to late readmission after PCI [11]. The late readmission of patients after PCI not only increases the economic burden of the patients but also increases the social medical burden [12].…”

Section: Introductionmentioning

confidence: 99%

Influencing Factors and Survival Analysis of Late Readmission after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Zhou,

Pu,

Chen

2024

HSF

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Objective: This study aimed to explore the influencing factors analysis of late readmission after patients with acute myocardial infarction received percutaneous coronary intervention (PCI). Methods: A total of 368 patients with acute myocardial infarction who received PCI treatment in West China Hospital, Sichuan University/West China School of Nursing, Sichuan University from January 2018, to January 2021, were selected for the study. Among them, 110 subjects were excluded, and 258 subjects were finally included, of which 124 were readmitted and 134 were not readmitted. The baseline data and clinical characteristics of the patients were collected, and the influencing factors of readmission were analyzed by logistic regression analysis. The readmitted patients were followed up for 12 months. The Kaplan–Meier method was used to analyze the survival of patients with delayed readmitted and calculate the survival rate. Results: Significant differences were found between readmitted patients and non-readmitted patients in terms of age, chronic obstructive pulmonary disease (COPD), history of early coronary heart disease, history of hypertension, history of oral anticoagulant drugs, and left ventricle ejection fraction (LVEF, p < 0.05). No significant differences were observed in gender, body mass index, family history of acute myocardial infarction, history of chronic kidney disease, history of diabetes, history of smoking, history of drinking, and the number of implanted stents and diseased vessels (p > 0.05). Binary logistic regression analysis showed that age, COPD, history of premature coronary heart disease, history of oral anticoagulant drugs, and LVEF were important influencing factors of delayed readmission after PCI (all p < 0.05). Follow-up results showed that 125 patients survived and nine died among the delayed non-readmission patients after PCI. Among the patients with delayed readmission, 95 survived and 29 died. Kaplan–Meier survival analysis showed that the survival time of patients with delayed non-readmission was longer than that of patients with delayed readmission, and the difference was statistically significant (χ2 = 17.696, p < 0.001). Conclusion: Age, COPD, history of oral anticoagulant drugs, and LVEF are important influencing factors of delayed readmission after PCI, and the survival time of patients with delayed non-readmission is longer than that of patients with delayed readmission.

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Device entrapment during percutaneous coronary intervention

Cited by 12 publications

References 36 publications

The lost balloon at midnight: a case report reveals the inevitability of heart team existence

The lost balloon at midnight: a case report reveals the inevitability of heart team existence

How to manage balloon entrapment during percutaneous coronary intervention of a calcified lesion “Case report”

Influencing Factors and Survival Analysis of Late Readmission after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

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