A Review of Catheter Related Complications During Minimally Invasive Transcatheter Cardiovascular Intervention with Implications for Catheter Design

Abstract

The objectives of this study are to identify the most important complications associated with transcatheter cardiovascular intervention and to obtain insights into those complications which are directly related to mechanical interaction between the blood vessel and the catheter, by performing a literature review. Using the insights gained, several generic strategies for improving catheter design to minimize mechanical interaction are proposed, which are aimed at reducing complication prevalence and mortality during transcatheter cardiovascular intervention. Data were gathered from the literature on complications associated with four common transcatheter cardiovascular intervention procedures, including percutaneous coronary intervention, trans-catheter aortic valve implantation and structural heart disease interventions, radiofrequency current ablative cardiac catheterization and endovascular aneurysm repair. To gain insight into the relative importance of each complication and the influence of catheterization, the range of prevalence and mortality rates, from the lowest to the highest, were determined for each procedure considered. Additional insights were obtained by plotting the highest prevalence and mortality rates graphically, while also differentiating between complications which are directly and indirectly or unrelated to mechanical interaction between blood vessels and the catheter. The data revealed that mechanical interaction between endovascular catheters and the blood vessel lumen is one of the most important sources of transcatheter cardiovascular intervention complications. Among the most prevalent mechanically-related complications are vascular trauma, hemorrhage and arterial spasm. Improvements to endovascular catheter design which passively protect against complication occurrence and those that actively prevent the operator from causing harm may help to significantly reduce the prevalence as well as mortality of many transcatheter cardiovascular intervention complications.