Tejas Patel, MD | Sanjay Shah, MD | Samir B. Pancholy, MD

Chapter 6: Managing Trapped Devices in the Coronary and Peripheral Circulation

Entrapment of a device in the coronary system is one of the most distressing complications of percutaneous coronary intervention (PCI). Due to its rare occurrence, many operators may not be familiar with retrieval techniques and the special hardware potentially available for use. Fortunately, the incidence of this complication during PCI has been reduced significantly in recent years, because of technological improvements in equipment design and the almost universal use of pre-mounted stents.1-5 Devices that can dislodge, break, embolize, or become trapped in the coronary tree include but may not be limited to stents, coronary wires, balloons, intravascular ultrasound (IVUS) catheters, optical coherence tomography (OCT) catheters, distal protection devices, and Rotablator burrs (Boston Scientific).4-11 When one considers removal of a trapped device, it is useful to first review the literature to learn from the experiences of others. Second, a well-stocked inventory of various sizes of intravascular sheaths, snare devices, and intravascular forceps should be handy to the operator. Knowledge of the percutaneous management of these rare complications may help avoid bail-out cardiac surgery and serious complications, such as stroke, vessel perforation, myocardial infarction (MI), and death.2-5,11-14

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