Device fracture as a potential complication of a left ventricular microaxial pump catheter: a case report

Background: The use of an Impella pump catheter has advanced substantially in the last few years due to the simple insertion procedure and smaller device size. However, its use is still associated with some risks and complications. Here, we report a device fracture as a rare complication that occurred during the device extraction a few days after the initial insertion. Case summary: A 74-year-old man with cardiogenic shock due to acute non-ST-segment elevation myocardial infarction presented to our hospital, and he was transferred to the cath lab for emergency percutaneous coronary intervention (PCI). An Impella CP pump was inserted without any complication prior to PCI. After successful PCI, the patient was transferred to the intensive care unit with device left for continued haemodynamic support. After 3 days, as the patient's condition remarkably improved, we tried to remove the device. However, a persistent mechanical resistance hindered the further catheter retraction; therefore, a decision was made to remove the catheter under fluoroscopy. Indeed, the fluoroscopy revealed a broken distal part of the pump at the level of the ascending aorta. The retained catheter tip was eventually snared with a snare catheter and removed without any complication. Discussion: An Impella microaxial pump may improve the overall outcome by providing haemodynamic support in critically ill patients. However, its application is not without complications. Intravascular device tip fracture, as demonstrated in this case report, is a rarely reported complication. The use of a snare catheter can be an option in retrieving a broken pump.