Management of Undeflatable Coronary Balloons During Percutaneous Coronary Intervention: A Case-Based Review and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Failure

Background:

• Undeflatable coronary balloons during percutaneous coronary intervention (PCI) are infrequent but pose significant risks.
• Persistent inflation can lead to abrupt coronary occlusion, ischemia, and hemodynamic compromise.

Purpose of the Study:

• To synthesize published cases of undeflatable coronary balloons.
• To define mechanistic patterns and identify predisposing factors.
• To propose a practical bailout algorithm for managing these events.

Main Methods:

• A case-based review of PubMed, Cochrane Library, and EBSCO databases.
• Inclusion criteria: reports of balloons unable to be deflated in a coronary artery.
• Analysis of 15 coronary cases from 2011-2025.

Main Results:

• Events often occurred during post-dilatation or after stent deployment in complex anatomies.
• Common factors included severe calcification, aorto-ostial segments, and chronic total occlusions.
• Two mechanistic patterns identified: intact-system non-deflation and shaft-compromised events.

Conclusions:

• Undeflatable balloons have distinct failure modes requiring tailored rescue strategies.
• Successful outcomes depend on rapid perfusion restoration and early recognition of device integrity.
• A structured escalation approach can reduce iatrogenic harm.