Iturbe Jose Miguel, Abdel-Karim Abdul-Rahman R, Papayannis Aristotelis, Mahmood Arif, Rangan Bavana V, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Invasive Cardiol. 2012 May;24(5):215-21.
Device loss and entrapment are infrequent but potentially grave complications of percutaneous coronary interventions (PCI). There are limited contemporary data on the frequency, treatment, and consequences of these complications.
We reviewed 2338 consecutive PCI cases performed between 1/2005 and 5/2010 at our institution to identify cases of device loss or entrapment. The angiograms and outcomes of these patients were reviewed.
During the study period, device loss occurred in 9 cases (0.38%; 95% confidence interval [CI], 0.18%-0.73%) and entrapment in 4 cases (0.17%; 95% CI, 0.05%-0.44%). The lost devices were stents (n = 5; 0.21%), a coronary balloon shaft (n = 1; 0.04%), a femoral arterial sheath (n = 1; 0.04%), an arterial catheter (n = 1; 0.04%), and an Ostial Pro catheter (Ostial Solutions) distal tip (n = 1; 0.04%). Entrapped devices included a coronary guidewire (n = 2; 0.08%), a Tornus catheter (Abbott Vascular; n = 1; 0.04%) and a Filterwire (Boston Scientific; n = 1; 0.04%). All patients with device loss were successfully managed percutaneously (1 patient experienced periprocedural myocardial infarction). Retrieval of the lost devices was attempted in 7 of 9 cases (78%) and was successful in 6 cases (86%). Retrieval was successful with the initial attempt in 2 patients but required >1 attempt in 4 patients. In contrast, 3 of 4 patients (75%) with device entrapment required emergency surgical removal and coronary artery bypass grafting.
Device loss or entrapment is an infrequent complication of contemporary PCI. Device loss can be successfully managed percutaneously, whereas device entrapment often requires emergency cardiac surgery.
器械丢失和嵌顿是经皮冠状动脉介入治疗（PCI）中罕见但可能严重的并发症。关于这些并发症的发生率、治疗及后果，当代数据有限。
我们回顾了2005年1月至2010年5月在我院连续进行的2338例PCI病例，以确定器械丢失或嵌顿的病例。对这些患者的血管造影结果和预后进行了回顾。
在研究期间，9例发生器械丢失（0.38%；95%置信区间[CI]，0.18% - 0.73%），4例发生器械嵌顿（0.17%；95% CI，0.05% - 0.44%）。丢失的器械包括支架（n = 5；0.21%）、冠状动脉球囊导管杆（n = 1；0.04%）、股动脉鞘（n = 1；0.04%）、动脉导管（n = 1；0.04%）以及Ostial Pro导管（Ostial Solutions）远端尖端（n = 1；0.04%）。嵌顿的器械包括冠状动脉导丝（n = 2；0.08%）、Tornus导管（雅培血管；n = 1；0.04%）和Filterwire（波士顿科学；n = 1；0.04%）。所有器械丢失患者均经皮成功处理（1例患者发生围手术期心肌梗死）。9例中有7例（78%）尝试取出丢失的器械，6例（86%）成功。2例患者首次尝试即成功取出，但4例患者需要多次尝试。相比之下，4例器械嵌顿患者中有3例（75%）需要紧急手术取出并进行冠状动脉旁路移植术。
器械丢失或嵌顿是当代PCI中罕见的并发症。器械丢失可经皮成功处理，而器械嵌顿通常需要紧急心脏手术。
