Management of Microcatheter Fracture in Complex Percutaneous Coronary Intervention With Laser Atherectomy

Microcatheters and dedicated guidewires for both chronic total occlusion (CTO) and non-CTO percutaneous coronary intervention (PCI) are increasingly being used to overcome complex coronary anatomy with severe tortuosity and calcification. In extremely resistant lesions, a potential over-rotation and device fatigue may result in entrapment or even fracture causing abrupt vessel closure and hinder successful revascularization.

We demonstrate two consecutive cases complicated with dislodged microcatheter tip which was rescued uniquely with coronary laser atherectomy. We describe an algorithmic approach for management of microcatheter fracture which are increasingly occur in contemporary practice of complex PCI.

In summary, our cases illustrate the feasibility of using coronary excimer laser system to release fractured and entrapped intracoronary MC tips when other conventional percutaneous techniques fail.