Balloon Rupture-Facilitated Grenadoplasty in Complex Left Anterior Descending Chronic Total Occlusion
Pierluigi Demola1, David Rutigliano2, Sergio Rutigliano3
1Department of Cardiology, Ospedale della Murgia "F. Perinei", ASL Bari, Bari, Italy.
Insights
Unintentional balloon rupture during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) can facilitate lesion crossing and stent implantation. This rare event may serve as a bailout strategy in complex CTO PCI cases.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is a complex procedure indicated for symptomatic patients or those with significant ischemic burden.
- The decision to proceed with PCI for CTO involves balancing potential clinical benefits against procedural risks.
Background:
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is indicated in selected patients with symptoms or significant ischemic burden, balancing clinical benefit against procedural risk.
Case Summary:
A 66-year-old man with inferolateral ST-segment elevation myocardial infarction was found to have a calcified ostial left anterior descending artery CTO. During staged antegrade CTO PCI, high-pressure balloon inflation at the proximal cap resulted in an unintentional balloon rupture, creating a focal microdissection without perforation. This event enabled true-lumen wiring, lesion preparation, and successful stent implantation with optimal angiographic and intravascular ultrasound results.
Discussion:
The mechanism was consistent with balloon-assisted microdissection rather than hydrodynamic contrast recanalization. Although unintentional, the rupture facilitated plaque modification and re-entry.
Take-Home Message:
Unintentional balloon rupture may rarely act as a bailout mechanism during complex CTO PCI but should never be considered a routine strategy.
