Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention

Michaella Alexandrou; Athanasios Rempakos; Deniz Mutlu; Ahmed Al Ogaili; James W. Choi; Paul Poommipanit; Khaldoon Alaswad; Mir Babar Basir; Rhian Davies; Farouc A. Jaffer; Raj H. Chandwaney; Lorenzo Azzalini; Nazif Aygul; Phil Dattilo; Brian K. Jefferson; Sevket Gorgulu; Jaikirshan J. Khatri; Oleg Krestyaninov; Jarrod Frizzell; Basem Elbarouni; Bavana V. Rangan; Olga C. Mastrodemos; M. Nicholas Burke; Yader Sandoval; Emmanouil S. Brilakis

doi:10.25270/jic/23.00266

Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention

Michaella Alexandrou, Athanasios Rempakos, Deniz Mutlu, Ahmed Al Ogaili, James W. Choi, Paul Poommipanit, Khaldoon Alaswad, Mir Babar Basir, Rhian Davies, Farouc A. Jaffer, Raj H. Chandwaney, Lorenzo Azzalini, Nazif Aygul, Phil Dattilo, Brian K. Jefferson, Sevket Gorgulu, Jaikirshan J. Khatri, Oleg Krestyaninov, Jarrod Frizzell, Basem ElbarouniBavana V. Rangan, Olga C. Mastrodemos, M. Nicholas Burke, Yader Sandoval, Emmanouil S. Brilakis

Research output: Contribution to journal › Article › peer-review

Abstract

Background. There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods. 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. Results. 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 < .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 < .001), acute myocardial infarction (7.5% vs 0.4%, P < .001), emergency coronary artery bypass graft (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P < .001), and death (7.5% vs 0.4%, P < .001). Conclusions. 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.

Original language	English
Journal	Journal of Invasive Cardiology
Volume	36
Issue number	4
DOIs	https://doi.org/10.25270/jic/23.00266
State	Published - Apr 2024
Externally published	Yes

Keywords

CTO-PCI
Chronic Total
Complications
Coronary
Equipment
Intervention
Occlusion
Percutaneous

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10.25270/jic/23.00266

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Alexandrou, M., Rempakos, A., Mutlu, D., Al Ogaili, A., Choi, J. W., Poommipanit, P., Alaswad, K., Basir, M. B., Davies, R., Jaffer, F. A., Chandwaney, R. H., Azzalini, L., Aygul, N., Dattilo, P., Jefferson, B. K., Gorgulu, S., Khatri, J. J., Krestyaninov, O., Frizzell, J., ... Brilakis, E. S. (2024). Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention. Journal of Invasive Cardiology, 36(4). https://doi.org/10.25270/jic/23.00266

@article{b3642fdfedd544a5b538c7876af63495,

title = "Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention",

abstract = "Background. There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods. 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. Results. 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 < .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 < .001), acute myocardial infarction (7.5% vs 0.4%, P < .001), emergency coronary artery bypass graft (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P < .001), and death (7.5% vs 0.4%, P < .001). Conclusions. 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.",

keywords = "CTO-PCI, Chronic Total, Complications, Coronary, Equipment, Intervention, Occlusion, Percutaneous",

author = "Michaella Alexandrou and Athanasios Rempakos and Deniz Mutlu and {Al Ogaili}, Ahmed and Choi, {James W.} and Paul Poommipanit and Khaldoon Alaswad and Basir, {Mir Babar} and Rhian Davies and Jaffer, {Farouc A.} and Chandwaney, {Raj H.} and Lorenzo Azzalini and Nazif Aygul and Phil Dattilo and Jefferson, {Brian K.} and Sevket Gorgulu and Khatri, {Jaikirshan J.} and Oleg Krestyaninov and Jarrod Frizzell and Basem Elbarouni and Rangan, {Bavana V.} and Mastrodemos, {Olga C.} and {Nicholas Burke}, M. and Yader Sandoval and Brilakis, {Emmanouil S.}",

year = "2024",

month = apr,

doi = "10.25270/jic/23.00266",

language = "English",

volume = "36",

journal = "Journal of Invasive Cardiology",

issn = "1042-3931",

publisher = "Cliggott Publishing Co.",

number = "4",

}

Alexandrou, M, Rempakos, A, Mutlu, D, Al Ogaili, A, Choi, JW, Poommipanit, P, Alaswad, K, Basir, MB, Davies, R, Jaffer, FA, Chandwaney, RH, Azzalini, L, Aygul, N, Dattilo, P, Jefferson, BK, Gorgulu, S, Khatri, JJ, Krestyaninov, O, Frizzell, J, Elbarouni, B, Rangan, BV, Mastrodemos, OC, Nicholas Burke, M, Sandoval, Y & Brilakis, ES 2024, 'Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention', Journal of Invasive Cardiology, vol. 36, no. 4. https://doi.org/10.25270/jic/23.00266

TY - JOUR

T1 - Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention

AU - Alexandrou, Michaella

AU - Rempakos, Athanasios

AU - Mutlu, Deniz

AU - Al Ogaili, Ahmed

AU - Choi, James W.

AU - Poommipanit, Paul

AU - Alaswad, Khaldoon

AU - Basir, Mir Babar

AU - Davies, Rhian

AU - Jaffer, Farouc A.

AU - Chandwaney, Raj H.

AU - Azzalini, Lorenzo

AU - Aygul, Nazif

AU - Dattilo, Phil

AU - Jefferson, Brian K.

AU - Gorgulu, Sevket

AU - Khatri, Jaikirshan J.

AU - Krestyaninov, Oleg

AU - Frizzell, Jarrod

AU - Elbarouni, Basem

AU - Rangan, Bavana V.

AU - Mastrodemos, Olga C.

AU - Nicholas Burke, M.

AU - Sandoval, Yader

AU - Brilakis, Emmanouil S.

PY - 2024/4

Y1 - 2024/4

N2 - Background. There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods. 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. Results. 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 < .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 < .001), acute myocardial infarction (7.5% vs 0.4%, P < .001), emergency coronary artery bypass graft (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P < .001), and death (7.5% vs 0.4%, P < .001). Conclusions. 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.

AB - Background. There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods. 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. Results. 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 < .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 < .001), acute myocardial infarction (7.5% vs 0.4%, P < .001), emergency coronary artery bypass graft (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P < .001), and death (7.5% vs 0.4%, P < .001). Conclusions. 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.

KW - CTO-PCI

KW - Chronic Total

KW - Complications

KW - Coronary

KW - Equipment

KW - Intervention

KW - Occlusion

KW - Percutaneous

UR - http://www.scopus.com/inward/record.url?scp=85201515445&partnerID=8YFLogxK

U2 - 10.25270/jic/23.00266

DO - 10.25270/jic/23.00266

M3 - Article

AN - SCOPUS:85201515445

SN - 1042-3931

VL - 36

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

IS - 4

ER -

Equipment Entrapment/Loss During Chronic Total Occlusion Percutaneous Coronary Intervention

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Keywords

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