Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Texas Health Presbyterian Hospital, Dallas, Texas, USA.
J Invasive Cardiol. 2024 Apr;36(4). doi: 10.25270/jic/23.00266.
There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We analyzed the baseline clinical and angiographic characteristics and outcomes of equipment loss/entrapment at 43 US and non-US centers between 2017 and 2023.
Equipment loss/entrapment was reported in 40 (0.4%) of 10 719 cases during the study period. These included guidewire entrapment/fracture (n = 21), microcatheter entrapment/fracture (n = 11), stent loss (n = 8) and balloon entrapment/fracture/rupture (n = 5). The equipment loss/entrapment cases were more likely to have moderate to severe calcification, longer lesion length, higher J-CTO and PROGRESS-CTO complications scores, and use of the retrograde approach compared with the remaining cases. Retrieval was attempted in 71.4% of the guidewire, 90.9% of the microcatheter, 100% of the stent loss, and 100% of the balloon cases, and was successful in 26.7%, 30.0%, 50%, and 40% of the cases, respectively. Procedures complicated by equipment loss/entrapment had higher procedure and fluoroscopy time, contrast volume and patient air kerma radiation dose, lower procedural (60.0% vs 85.6%, P less than .001) and technical (75.0% vs 86.8%, P = .05) success, and higher incidence of major adverse cardiac events (MACE) (17.5% vs 1.8%, P less than .001), acute MI (7.5% vs 0.4%, P less than .001), emergency coronary artery bypass graft (CABG) (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P less than .001), and death (7.5% vs 0.4%, P less than .001).
Equipment loss is a rare complication of CTO PCI; it is more common in complex CTOs and is associated with lower technical success and higher MACE.
在慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中，器械丢失或嵌顿的数据有限。
我们分析了 2017 年至 2023 年期间 43 个美国和非美国中心的基线临床和血管造影特征以及器械丢失/嵌顿的结局。
在研究期间，报告了 10719 例患者中有 40 例（0.4%）发生器械丢失/嵌顿。这些包括导丝嵌顿/断裂（n=21）、微导管嵌顿/断裂（n=11）、支架丢失（n=8）和球囊嵌顿/断裂/破裂（n=5）。与其余病例相比，器械丢失/嵌顿病例更可能存在中度至重度钙化、较长的病变长度、较高的 J-CTO 和 PROGRESS-CTO 并发症评分以及逆行入路的使用。在 71.4%的导丝、90.9%的微导管、100%的支架丢失和 100%的球囊病例中尝试了取回，分别有 26.7%、30.0%、50%和 40%的病例成功取回。发生器械丢失/嵌顿的操作程序具有更高的操作和透视时间、对比剂体积和患者空气比释动能剂量，更低的操作成功率（60.0% vs 85.6%，P 小于.001）和技术成功率（75.0% vs 86.8%，P=.05），更高的主要不良心脏事件（MACE）发生率（17.5% vs 1.8%，P 小于.001）、急性心肌梗死（7.5% vs 0.4%，P 小于.001）、急诊冠状动脉旁路移植术（CABG）（2.5% vs 0.1%，P=.03）、穿孔（20.0% vs 4.9%，P 小于.001）和死亡（7.5% vs 0.4%，P 小于.001）。
器械丢失是 CTO PCI 的罕见并发症；它在复杂 CTO 中更为常见，与技术成功率较低和更高的 MACE 相关。
