title: Frequency, treatment, and consequences of device loss and entrapment in contemporary percutaneous coronary interventions.
abstract: BACKGROUND
  Device loss and entrapment are infrequent but potentially grave complications of percutaneous coronary interventions (PCI). There are limited contemporary data on the frequency, treatment, and consequences of these complications.
  
  
  METHODS
  We reviewed 2338 consecutive PCI cases performed between 1/2005 and 5/2010 at our institution to identify cases of device loss or entrapment. The angiograms and outcomes of these patients were reviewed.
  
  
  RESULTS
  During the study period, device loss occurred in 9 cases (0.38%; 95% confidence interval [CI], 0.18%-0.73%) and entrapment in 4 cases (0.17%; 95% CI, 0.05%-0.44%). The lost devices were stents (n = 5; 0.21%), a coronary balloon shaft (n = 1; 0.04%), a femoral arterial sheath (n = 1; 0.04%), an arterial catheter (n = 1; 0.04%), and an Ostial Pro catheter (Ostial Solutions) distal tip (n = 1; 0.04%). Entrapped devices included a coronary guidewire (n = 2; 0.08%), a Tornus catheter (Abbott Vascular; n = 1; 0.04%) and a Filterwire (Boston Scientific; n = 1; 0.04%). All patients with device loss were successfully managed percutaneously (1 patient experienced periprocedural myocardial infarction). Retrieval of the lost devices was attempted in 7 of 9 cases (78%) and was successful in 6 cases (86%). Retrieval was successful with the initial attempt in 2 patients but required >1 attempt in 4 patients. In contrast, 3 of 4 patients (75%) with device entrapment required emergency surgical removal and coronary artery bypass grafting.
  
  
  CONCLUSIONS
  Device loss or entrapment is an infrequent complication of contemporary PCI. Device loss can be successfully managed percutaneously, whereas device entrapment often requires emergency cardiac surgery.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Iturbe
authors.forename: Abdul-Rahman R
authors.initials: AR
authors.lastname: Abdel-Karim
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Papayannis
authors.forename: Arif
authors.initials: A
authors.lastname: Mahmood
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D017023:Coronary Angiography; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D015607:Stents