Balloon-Assisted Stent Advancement Technique for Stent Delivery Failure in Complex Percutaneous Coronary Intervention

To describe a simple balloon-based maneuver-the balloon-assisted stent advancement technique-as a guide-extension-free alternative to facilitate stent delivery.

Advance a second guidewire distal to the target lesion. Position a small noncompliant balloon (1.5-2.0 mm) distal to the lesion and maintain complete deflation. Advance the coronary stent over the primary guidewire while using the balloon shaft as a passive mechanical rail. Withdraw the balloon after successful lesion crossing and perform standard stent deployment.

Potential complications include distal balloon migration, interaction between the stent and balloon shaft, device crowding within the guiding catheter, and distal vessel injury. Careful balloon positioning and maintenance of complete balloon deflation are essential.

Balloon-assisted stent advancement technique may facilitate stent delivery in selected complex non-CTO coronary lesions without the need for guide-extension catheters. Proper lesion preparation and careful procedural execution are critical to ensure safe and effective use of the technique.