Successful surgical removal of an entrapped intravascular ultrasonography catheter in the left circumflex coronary artery

Abstract

Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). A 67-year-old man who presented with exertional chest pain had an angiographic finding of 99 % stenosis of left circumflex coronary artery. PCI with stent implantation was performed successfully with an assessment by IVUS showing adequate stent expansion and apposition. When the IVUS catheter was retracted, it became trapped at the stent strut. The stent was deformed and the IVUS catheter became stuck there. Ventricular fibrillation suddenly occurred with deterioration of the coronary flow. He was transferred to the operating room just after insertion of intra-aortic balloon pumping. The IVUS catheter, the guidewire, and the deformed stent were all removed under cardiopulmonary bypass. Coronary artery bypass graft with a saphenous vein was also performed at the more distal segment from the entrapment site. The postoperative course was uneventful with no graft occlusion.

Surgical Removal of A Broken Intravascular Ultrasonography Catheter for PCI Followed by Off-Pump Coronary Artery Bypass

“…When they become entrapped, most stents are removed using a catheter device such as a snare wire 3) . Some cases of surgical removal have been reported [4][5][6][7] . Several methods have been reported to deal with situations in which an IVUS catheter becomes entrapped 8) .…”

“…Regarding the procedure of coronary artery incision for device removal, there have been reports of direct closure of the coronary artery incision 4) and patch closure using the saphenous vein 5) .…”

Coronary artery bypass graft surgery for right coronary artery: balloon catheter entrapment

“…Despite technical improvements and increased experience in PCIs over time, mechanical complications like catheter entrapment, as seen in our case, do still occur in the current era. [3,4] Some other complications including myocardial infarction (MI), [5] bleeding, or vascular access complications, [6] stent deployment failure, [7] contrast nephropathy, stroke, tamponade, stent thrombosis and radiation skin injury [8] are also associated with the use of PCIs. High rates ranging from 5% to 30% of patients undergoing PCI, are reported to have evidence of a peri-procedural MI.…”

Incidence, retrieval methods, and outcomes of intravascular ultrasound catheter stuck within an implanted stent: Systematic literature review

“…If equipment such as a balloon catheter is retained or entrapped in the coronary artery, this can lead to myocardial ischemia, infarction, and lethal arrhythmias [12]. Entrapment of IVUS catheter is a rare but serious complication associated with percutaneous coronary intervention (PCI), and a surgical procedure is infrequently required to retrieve it [13]. Interventional retrieval should be attempted first.…”