Kompleks bir CTO müdahalesi sırasında sıkışan ve kopan bir mikrokateter ucu için başarılı bir yönetim vakası
Abstract
Kronik total tıkanıklıklar (KTO), koroner arter hastalığında teknik olarak en zorlu müdahale alanlarından biridir ve sıklıkla şiddetli kalsifikasyon ve zor damar anatomisi ile komplike olabilir. Mikrokateterler KTO perkütan koroner girişiminde (PKG) önemli bir rol oynar, ancak özellikle kalsifiye lezyonlarda uç sıkışması ve kırılması gibi nadir komplikasyonlara yol açabilirler. Bu çalışmada, sağ koroner arterdeki karmaşık KTO PKG sırasında mikrokateter ucu kırılması olgusu sunulmuştur. Kopan segmentin yanından paralel tel tekniği kullanılarak geçiş sağlanmış ve ardından mikrokateter parçası stent ile damar duvarı arasına ezilerek sabitlenmiştir. Bu yöntemle komplikasyon olmadan tam revaskülarizasyon sağlanmıştır. Olgu, kullanılan malzemelerin mekanik sınırlarının iyi anlaşılmasının, prosedürel komplikasyonlara hazırlıklı olunmasının ve balon destekli kaydırma tekniği gibi alternatif stratejilerin kullanılmasının önemini vurgulamaktadır. Koroner kalsifikasyonun artan prevalansı göz önüne alındığında, bu tür komplikasyonların farkındalığı ve etkin yönetimi optimal hasta sonuçları için giderek daha kritik hale gelmektedir.
References
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- Megaly M, Sedhom R, Pershad A, Vemmou E, Nikolakopoulos I, Karacsonyi J, et al. Complications and failure modes of coronary microcatheters: Coronary microcatheter complications. EuroIntervention. 2021;17(5):e436.
- Sadiq MA, Al Riyami AB, Khatri MA, Omar HB. Unexpected Entrapment of Caravel Microcatheter in Percutaneous Chronic Total Coronary Intervention. Sultan Qaboos University Medical Journal. 2024;24(2):300.
- Gasparini G-L, Sanz-Sanchez J, Regazzoli D, Boccuzzi G, Oreglia J, Gagnor A, et al. Device entrapment during percutaneous coronary intervention of chronic total occlusions: incidence and management strategies: Device entrapment in chronic total occlusions. EuroIntervention. 2021;17(3):212.
- Hashimoto S, Takahashi A, Yamada T, Mizuguchi Y, Taniguchi N, Nakajima S, et al. Usefulness of the twin guidewire method during retrieval of the broken tip of a microcatheter entrapped in a heavily calcified coronary artery. Cardiovascular Revascularization Medicine. 2018;19(8):28-30.
- Sinha SK, Tripathi S, Rekwal L, Singh AK, Abhishekh NK. Balloon Assisted Sliding and Tracking of GuideLiner Catheter (BLAST-G) to successfully deliver stent in a calcified, tortuous lesion: case report. Folia Cardiologica. 2018;13(3):247-51.
A case of successful management of a trapped and fractured microcatheter tip during a complex CTO intervention
Abstract
Chronic total occlusions (CTOs) represent one of the most technically challenging subsets in coronary artery disease interventions, frequently complicated by severe calcification and difficult vessel anatomy. Microcatheters play a crucial role in CTO percutaneous coronary intervention (PCI), but their use can lead to rare complications such as tip entrapment and fracture, especially in calcified lesions. We present a case of microcatheter tip fracture during complex right coronary artery CTO PCI, managed successfully by employing a parallel-wire technique to bypass the fractured segment followed by stent deployment to crush and trap the fragment against the vessel wall. This approach resulted in complete revascularization without adverse events. The case highlights the importance of understanding device limitations, preparing for procedural complications, and utilizing alternative strategies such as the balloon-assisted sliding technique. As coronary calcification prevalence rises, awareness and effective management of such complications are increasingly critical for optimal patient outcomes.
Keywords
Chronic total occlusion Microcatheter fracture Coronary calcification Balloon-assisted sliding
Ethical Statement
Ethical approval was not obtained because it is a case report.
Supporting Institution
The authors received no financial support for the research, authorship, and/or publication of this article.
References
- Young MN, Secemsky EA, Kaltenbach LA, Jaffer FA, Grantham JA, Rao SV, et al. Examining the operator learning curve for percutaneous coronary intervention of chronic total occlusions: a report from the National Cardiovascular Data Registry. Circulation: Cardiovascular Interventions. 2019;12(8):e007877.
- Vemmou E, Nikolakopoulos I, Xenogiannis I, Megaly M, Hall A, Wang Y, et al. Recent advances in microcatheter technology for the treatment of chronic total occlusions. Expert review of medical devices. 2019;16(4):267-73.
- Kovacic M, Cocoi M, Leibundgut G. Equipment for Chronic Total Occlusions Percutaneous Coronary Intervention: Present and Future. The American Journal of Cardiology. 2024;232:89-104.
- Goel PK, Sahu AK, Kasturi S, Roy S, Shah N, Parikh P, et al. Guiding principles for the clinical use and selection of microcatheters in complex coronary interventions. Frontiers in Cardiovascular Medicine. 2022;9:724608.
- Megaly M, Sedhom R, Pershad A, Vemmou E, Nikolakopoulos I, Karacsonyi J, et al. Complications and failure modes of coronary microcatheters: Coronary microcatheter complications. EuroIntervention. 2021;17(5):e436.
- Sadiq MA, Al Riyami AB, Khatri MA, Omar HB. Unexpected Entrapment of Caravel Microcatheter in Percutaneous Chronic Total Coronary Intervention. Sultan Qaboos University Medical Journal. 2024;24(2):300.
- Gasparini G-L, Sanz-Sanchez J, Regazzoli D, Boccuzzi G, Oreglia J, Gagnor A, et al. Device entrapment during percutaneous coronary intervention of chronic total occlusions: incidence and management strategies: Device entrapment in chronic total occlusions. EuroIntervention. 2021;17(3):212.
- Hashimoto S, Takahashi A, Yamada T, Mizuguchi Y, Taniguchi N, Nakajima S, et al. Usefulness of the twin guidewire method during retrieval of the broken tip of a microcatheter entrapped in a heavily calcified coronary artery. Cardiovascular Revascularization Medicine. 2018;19(8):28-30.
- Sinha SK, Tripathi S, Rekwal L, Singh AK, Abhishekh NK. Balloon Assisted Sliding and Tracking of GuideLiner Catheter (BLAST-G) to successfully deliver stent in a calcified, tortuous lesion: case report. Folia Cardiologica. 2018;13(3):247-51.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiology |
| Journal Section | Case Report |
| Authors | |
| Submission Date | August 11, 2025 |
| Acceptance Date | September 26, 2025 |
| Publication Date | March 9, 2026 |
| DOI | https://doi.org/10.19161/etd.1760727 |
| IZ | https://izlik.org/JA65HX32ZK |
| Published in Issue | Year 2026 Volume: 65 Issue: 1 |
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