IVUS catheter entrapment and percutaneous retrieval: case report and literature review

2024 ESC Guidelines for the management of chronic coronary syndromes updated their recommendation for intravascular ultrasound (IVUS) guidance of PCI on anatomically complex lesions, particularly left main, bifurcations and long lesions to class 1, level A evidence. With more widespread use complex PCI operators are more likely to encounter complications and require an awareness of potential solutions.

A 66-year-old man presented with non-ST elevation acute coronary syndrome. Following PCI to the Left Main Stem the unusual complication of a trapped IVUS catheter was encountered. This was successfully retrieved by balloon trapping and pull-back method.

Literature review demonstrates that IVUS entrapment during complex PCI is an uncommon complication. Heavily calcified lesions, stents <2.5 mm and third-generation DES are considered risk factors. Several potential options for retrieval such as balloon trapping and use of Guide extension catheters have been described. This is the first reported case of IVUS entrapment in a large stent in Left Main Stem (LMS).