Donor Vessel Microcatheter Rupture During CTO-PCI Causing Hemodynamic Collapse: A Coil of the Coil Issue

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.

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.