Cocco Nino, Bianco Sabino, Agostoni Pierfrancesco, Ussia Gian Paolo
Operative Research Unit of Emodinamica, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
JACC Case Rep. 2025 Jul 30;30(21):104419. doi: 10.1016/j.jaccas.2025.104419.
Coiled microcatheters have substantially contributed to the success of retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI), thanks to their ability to cross challenging anatomies with only a marginal compromise in terms of support, but the increasing complexity is exposing new limitations associated with potential complications.
A patient undergoing CTO-PCI developed a rare complication with donor vessel occlusion due to a microcatheter coiling around a previously implanted stent. Despite the severity of the situation, artery patency was successfully restored. The patient experienced arrhythmic events in the intensive care unit, requiring ongoing hemodynamic support to stabilize the condition.
This scenario raises a crucial issue regarding complications related to coiled microcatheters, highlights the lifesaving value of CTO techniques in non-CTO settings, and remarks on the importance of percutaneous hemodynamic support in life-threatening complications.
TAKE-HOME MESSAGES: Coiled microcatheter entrapment can lead to severe complications during CTO-PCI, including stent crushing and donor vessel occlusion. Timely intervention with CTO techniques and hemodynamic support is crucial in managing life-threatening complications and stabilizing the patient.
盘绕微导管对逆行性慢性完全闭塞经皮冠状动脉介入治疗（CTO-PCI）的成功做出了重大贡献，这得益于其能够穿越具有挑战性的解剖结构，且仅在支撑方面有微小妥协，但日益增加的复杂性正暴露出与潜在并发症相关的新局限性。
一名接受CTO-PCI的患者出现了一种罕见并发症，即微导管缠绕在先前植入的支架上导致供血血管闭塞。尽管情况严重，但动脉通畅得以成功恢复。患者在重症监护病房发生心律失常事件，需要持续的血流动力学支持来稳定病情。
这种情况引发了一个关于盘绕微导管相关并发症的关键问题，凸显了CTO技术在非CTO情况下的救命价值，并强调了经皮血流动力学支持在危及生命的并发症中的重要性。
盘绕微导管陷入可导致CTO-PCI期间出现严重并发症，包括支架挤压和供血血管闭塞。及时采用CTO技术干预和血流动力学支持对于处理危及生命的并发症和稳定患者病情至关重要。
