A rare instructive complication of balloon catheter fracture during percutaneous coronary intervention

Device entrapment during percutaneous coronary intervention

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.

A stepwise approach utilizing a double helix wire technique, snare capture and a switch from a transfemoral to transradial approach to remove an entrapped balloon

During an attempted PCI utilizing a femoral approach, a balloon became entrapped in the Left Circumflex Artery. Initial retrieval efforts including pulling the balloon and inflating a second balloon over the entrapment failed, the balloon fractured, and the distal end of the balloon apparatus migrated out of the guide catheter. We utilized a stepwise approach with a double helix wiring technique, snares and a change from a transfemoral to transradial approach to successfully retrieve the foreign bodies. This case highlights the importance of utilizing multiple techniques in series and understanding anatomical influences on equipment retrieval when single techniques and approaches fail.

When Things Get Stuck: Gear Entrapment and Other Complications of Chronic Total Occlusion Percutaneous Coronary Intervention

Complex coronary artery intervention stresses the limits of both the operator's skills as well as the equipment being used for the procedure. This article is focused on avoiding, recognizing and dealing with device failure and gear entrapment during complex coronary intervention. The operator must understand how to avoid these complications by understanding the limits of devices and the need for adequate vessel preparation. This article focuses on giving the reader an algorithmic approach to recognizing when device failure/entrapment occurs and what specific maneuvers can be done to retrieve different devices and equipment safely.

Rotational Atherectomy in the Management of Ruptured and Entrapped Coronary Angioplasty Balloon

Retention and entrapment of angioplasty device fragments is a rare consequence of percutaneous coronary intervention (PCI). Due to advances in retrieval devices and introduction of new interventional techniques the need for emergency surgery has reduced significantly. There might also be clinical scenarios were remnants of retained fragments might have to be left within the coronary vessel and this might be the most appropriate option. Here we report a case of a ruptured non-compliant angioplasty balloon that was entrapped in the right coronary artery and retained in situ after multiple failed attempts at percutaneous retrieval. Medical therapy failed and hence rotation atherectomy had to be performed followed by stent implantation, there by jailing the retained fragments underneath the stent struts. To our knowledge this is the first description of rotational atherectomy of an entrapped balloon to allow for percutaneous revascularization.

A theoretical model to predict tensile deformation behavior of balloon catheter

In this technical note, a simple theoretical model was proposed to express the tensile deformation and fracture of balloon catheter tested by the ISO standard using piece-wise linear force-displacement relations. The model was then validated by comparing with the tensile force-displacement behaviors of two types of typical balloon catheters clinically used worldwide. It was shown that the proposed model can effectively be used to express the tensile deformation behavior and easily be handled by physicians who are not familiar with mechanics of materials.