A case of successful management of a trapped and fractured microcatheter tip during a complex CTO intervention

Hüseyin Kandemir; Çağlar Alp; Selçuk Öztürk; Nihat Kalay

doi:10.19161/etd.1760727

TR EN

Kompleks bir CTO müdahalesi sırasında sıkışan ve kopan bir mikrokateter ucu için başarılı bir yönetim vakası

Öz

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.

Anahtar Kelimeler

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

Supporting Institution

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

Ethical approval was not obtained because it is a case report.

References

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Details

Primary Language

English

Subjects

Cardiology

Journal Section

Case Report

Authors

Hüseyin Kandemir ^*
0000-0002-4462-7425
Türkiye

Çağlar Alp
0000-0001-5984-1857
Türkiye

Selçuk Öztürk
0000-0002-3426-1212
Türkiye

Nihat Kalay
0000-0001-5800-7094
Türkiye

Publication Date

March 9, 2026

Submission Date

August 11, 2025

Acceptance Date

September 26, 2025

Published in Issue

Year 2026 Volume: 65 Number: 1

DOI

https://doi.org/10.19161/etd.1760727

IZ

https://izlik.org/JA65HX32ZK

Cite

RIS / Bibtex

Vancouver

1.Hüseyin Kandemir, Çağlar Alp, Selçuk Öztürk, Nihat Kalay. A case of successful management of a trapped and fractured microcatheter tip during a complex CTO intervention. EJM. 2026 Mar. 1;65(1):177-81. doi:10.19161/etd.1760727