Unexpected complication- fracture of the IVUS catheter and percutaneous retrieval of a broken IVUS catheter tip from the right coronary artery.

Fracture of the IVUS catheter is very rare and, but when occurs they may lead to life-threating complications, such as embolization, thrombus formation and perforation. A 58-year-old man who had history of smoking, dyslipidemia and type II diabetes mellitus presented with an inferior ST-elevation myocardial infarction and underwent emergent coronary angiography. His coronary angiography showed nonsignificant stenosis of the mid portion of left anterior descending artery and 60% stenosis of the mid portion of the right coronary artery (RCA) (Fig. 1, Video 1. See corresponding video/movie images at www.anakarder.com). A complex RCA lesion was suspected, prompting further interrogation with the use of intravascular ultrasound (IVUS) catheter. A 7 French (F) JR 4.0 cm guiding catheter was engaged in the RCA and a floppy guidewire was inserted into the RCA. When the 2.9 F iMAPIVUS catheters (Boston Scientific, Santa Clara, CA, USA) were withdrawn under fluoroscopy without resistance, the distal marker IVUS catheter was separated and this segment was moved toward the postero-lateral artery (Fig. 2, Video 2. See corresponding video/movie images at www.anakarder.com). We realized the tip of IVUS catheter had broken off. A variety of catheter devices, including the loop snare catheter, basket catheter and grasping/biopsy forceps was developed and using these devices, foreign bodies could be retrieved cooperatively safely and promptly. Percutaneous retrieval of the broken segment was attempted. Snare catheter was passed over the guidewire and inserted