Mechanical Rotational Intravascular Ultrasound Catheter Suicide: A Word of Caution

Intravascular ultrasound (IVUS) is a critical adjunct in percutaneous coronary intervention (PCI), improving clinical outcomes. While generally safe, mechanical IVUS systems carry a rare risk of catheter entrapment. We report a case of IVUS catheter entrapment during percutaneous intervention of a heavily calcified lesion. Entrapment occurred when the imaging function was activated during catheter advancement through a tight lesion, leading to sheath compression, torsional distortion, and knotting. The catheter was successfully retrieved using balloon-assisted modification. The patient later underwent staged PCI without complication. This case highlights a unique entrapment mechanism specific to mechanical IVUS systems, emphasizing the importance of avoiding early imaging activation and forceful advancement through stenotic lesions. Understanding IVUS mechanics and available bailout techniques is critical for management of this complication. Awareness of this underrecognized complication and adherence to proper protocols can help prevent mechanical IVUS entrapment and ensure safe PCI outcomes.