Frequency, treatment, and consequences of device loss and entrapment in contemporary percutaneous coronary interventions.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.