Trapping as retrieval technique to resolve a ruptured and entrapped coronary balloon catheter

A 69 year old male, with a previous percutaneous revascularization of the mid-circumflex with a bare metal stent in 2007 was admitted to our centre for unstable angina. The angiography showed a severely calcified coronary tree with a functionally severe plaque on the proximal left anterior descending artery (LAD) and a critical focal lesion on the proximal right coronary artery. After a high pressure predilation on the proximal LAD, the balloon ruptured causing a retrograde LAD-left main (LM) dissection that was rapidly sealed with three overlapping zotarolimus-eluting stents from medial LAD to LM. We then used a new non-compliant balloon for successive aggressive postdilation. After a difficult handling, when the balloon catheter was pulled out of the body and we realized that the tip and membranous part of the balloon-catheter was separated from the rest, and entangled at the LM. After a first approach to retrieve the dislodged balloon with a snare, the ruptured balloon was successfully removed by trapping and withdrawing the whole system, including the guiding catheter and the wire.