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Intravascular Ultrasound-Guided Balloon Spacer Technique for Unstable Device Passage During LAD PCI
Naoki Shibata1, Yasuhiro Morita1, Yasunori Kanzaki1
1Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan.
Background:
Coronary dissection during percutaneous coronary intervention (PCI) may create a dissection-related cavity that destabilizes device passage. When rewiring alone does not ensure stable true-lumen device delivery, a balloon spacer technique may serve as a bailout option.
Case Summary:
A man in his 50s underwent staged PCI for severe mid-left anterior descending artery stenosis. After cutting-balloon dilation, intravascular ultrasound (IVUS) suggested a dissection-related cavity. IVUS-guided rewiring placed a second guidewire in the true lumen, but repeat balloon passage followed the cavity. IVUS-based assessment guided selection of a 1.5 × 10 mm semicompliant balloon for focal occlusion, after which stents were successfully delivered.
Discussion:
This case highlights the gap between true-lumen rewiring and stable device passage during PCI-related dissection.
Take-Home Messages:
True-lumen rewiring does not necessarily ensure stable device passage. IVUS may help guide balloon spacer bailout when device passage remains unstable after rewiring.