Quality Improvement Tip of the Month: Entrapped Equipment-Quality Improvement Tip of the Month: Entrapped Equipment

Video Transcription

Video Summary

Dr. Kocher, along with Drs. Crose and Bangler, discuss managing entrapped equipment during complex percutaneous coronary intervention (PCI), a rare but serious complication. They emphasize assessing patient stability first—symptoms and hemodynamics guide urgency. Strategies vary by equipment type: stents, balloons, microcatheters, atherectomy burrs, wire tips. Common approaches include retrieving, pushing distally, or embedding equipment against vessel walls.<br /><br />Key principles include maintaining wire access, minimizing distance between equipment and guide catheter (using guide liners), using balloons to trap or free stuck devices, and employing snares for removal. They caution against premature or forceful pulling which risks vessel injury or equipment fracture.<br /><br />Case examples illustrate these strategies: removing a stuck balloon with a gooseneck snare after unsuccessful attempts to deflate it; retrieving an entrapped rotaburr by cutting the shaft and advancing a guide extender; fishing out a fallen laser marker band by threading and inflating a balloon through it; and freeing a stuck microcatheter in heavily calcified vessels with high-pressure balloon inflation (granuloplasty).<br /><br />Prevention includes careful technique, especially in tortuous and calcified arteries —slow "pecking" burr advances at appropriate speeds reduce risk. In extreme cases, surgical consultation may be necessary. Overall, an algorithmic, calm, and methodical approach prioritizing patient safety enables percutaneous resolution in over 90% of cases.

Asset Caption

closed captions are computer-generated

Keywords

percutaneous coronary intervention

entrapped equipment

stent retrieval

balloon catheter

microcatheter

atherectomy burr

guide catheter techniques

vascular complication management