Successful Management of a Fractured Microcatheter During Retrograde CTO Intervention

We describe the successful management of a 60-year-old male patient with chronic chest pain, a history of hypertension, and previous percutaneous coronary intervention in the right coronary artery. After initial failure with an antegrade approach, a retrograde approach using a 1.7-F APT microcatheter (Instantpass, APT Medical) and guidewires resulted in the fracturing of the microcatheter within the septal branch. The decision was made to leave the fractured device in situ because of its minimal impact on coronary blood flow. Subsequently, the occlusion in the left anterior descending artery was successfully crossed using a CP 8-20 guidewire, and 2 drug-eluting stents were implanted. The patient had a favorable clinical outcome, with no restenosis or recurrence of symptoms at 12-month follow-up. This case highlights the challenges of chronic total occlusion intervention, particularly device fractures, and underscores the importance of tailored decision making and expertise in managing such complications.