Entrapped coronary catheter remnants and stents: must they be surgically removed?

Entrapment of catheter components during cardiologic interventions is rare but can cause life-threatening complications and the need for emergency cardiac surgery. We report our surgical series of patients who have experienced entrapped guidewires, Rotablator Systems, and stents after cardiologic interventions. Nine patients were referred for emergency surgery after entrapment of catheter remnants and ensuing acute ischemia. Guidewire fragments persisted in the left anterior descending coronary artery (2 patients) and in the right coronary artery (1 patient); Rotablator Systems lodged in the right coronary artery (2 patients); and stents were entrapped in the left anterior descending coronary artery (3 patients) and in the ramus circumflexus (1 patient). Patients were referred for surgical therapy within 132 +/- 30 min of device entrapment. Surgical procedures included coronary artery bypass grafting and removal of Rotablators or guidewires. Entrapped stents were left in situ, and additional coronary artery bypass grafting was performed. All patients survived. There were no signs of perioperative myocardial infarction. We conclude that surgical strategy has to be individualized in patients with entrapped catheter remnants. The removal of entrapped stents or small fragments of catheter components seems not to be mandatory, if these are contained within small, chronically occluded coronary vessels or within a distal segment.