Key result
Guiding catheter upsizing and subsequent stenting successfully resolves entrapped IVUS catheter and LMCA dissection.
Why the study?
Intravascular ultrasound catheter entrapment caused by extensive twisting of the catheter shaft in the left main coronary artery is a rare and severe complication specific to mechanical IVUS systems that presents a retrieval challenge.
Case Report (n=1)
No
This case report illustrates a rare, severe complication of mechanical IVUS catheter entrapment and iatrogenic left main dissection caused by extensive shaft twisting, which was successfully managed via catheter advancement, a larger guiding catheter, and subsequent stenting.
Answers are grounded in this paper and cite their sources.
Alerts operators to rare "catheter suicide" IVUS entrapment in LMCA; leaves open optimal retrieval strategies pending additional reports.
We report a rare case of intravascular ultrasound (IVUS) catheter entrapment in which extensive twisting of the catheter shaft prevented retrieval. In this phenomenon, termed "catheter suicide," the mechanical IVUS catheter twisted within the left main coronary artery (LMCA) and formed complex loops. Initial removal attempts were unsuccessful, and, during these bailout attempts, the imaging core of the IVUS catheter was found to be severed in its proximal portion. Subsequent imaging of another vessel confirmed extensive twisting, with associated iatrogenic dissection, as the cause of entrapment. Ex vivo experiments reproduced this rotational torque-driven complication. The twist was eventually released incidentally when the IVUS catheter was advanced further, and a larger guiding catheter was used, thereby facilitating safe retrieval. Subsequently, a stent was placed to treat the LMCA dissection, achieving thrombolysis in myocardial infarction (TIMI) grade 3 flow, and the patient was discharged without complications. This case illustrates a severe complication specific to mechanical IVUS systems and emphasizes the importance of prevention and early surgical consultation.
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Makinouchi et al. (2026) conducted a case report in Intravascular ultrasound catheter entrapment and iatrogenic dissection in the left main coronary artery (n=1). Catheter advancement with a larger guiding catheter and LMCA stenting was evaluated on Safe catheter retrieval and restoration of coronary flow. Catheter advancement with a larger guiding catheter and subsequent stenting resolved LMCA IVUS catheter entrapment and dissection, achieving TIMI grade 3 flow in 1 patient.
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