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Abrupt Pressure Delivery: A Novel Technique to Retrieve a Ruptured Entrapped Stent Balloon
Samir B Pancholy1, Sanjay Shah2, Aman T Patel2
1The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA.
Insights
A novel technique successfully managed a ruptured stent balloon during acute coronary syndrome intervention. This method, using conventional hardware, facilitated stent retrieval and successful treatment, improving patient outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Acute coronary syndrome (ACS) management involves complex percutaneous coronary intervention (PCI).
- Severe calcified coronary stenoses pose challenges during PCI, increasing complication risks like stent balloon rupture.
Observation:
- During PCI for severe calcified lesions in the left circumflex artery, a stent balloon ruptured.
- The ruptured balloon became entrapped, causing stent deformation, and conventional removal techniques failed.
Findings:
- A novel technique applying abrupt pressure successfully disengaged the ruptured balloon from the deformed stent.
- The deformed stent was subsequently expanded and successfully treated with restenting.
Implications:
- This case presents a simple, effective bailout strategy for stent balloon rupture during PCI using conventional hardware.
- The described technique may enhance procedural success rates in challenging coronary interventions.
Abstract:
A 71-year-old man with acute coronary syndrome was found to have multiple severe calcified stenoses in the dominant left circumflex coronary artery. After lesion preparation, the distal lesion was stented. A stent was advanced in the proximal lesion and inflated, but during the deployment inflation, the stent balloon ruptured after expansion of the proximal portion of the stent. The distal portion of the stent was unexpanded and bound to the stent balloon. Conventional techniques were used to remove the ruptured balloon without success and led to longitudinal stent deformation. A novel method to deliver abrupt pressure to the ruptured balloon was used, with successful disengagement of the ruptured stent balloon from the partially inflated stent and successful withdrawal. The deformed stent was successfully expanded with subsequent restenting. This case describes a simple technique for bailout with stent balloon rupture using conventional hardware, which may increase the probability of a successful outcome.
