Left Main Restenosis Due to a Retained Balloon Shaft: A First Report

Retained intracoronary devices are rare percutaneous coronary intervention complications with thrombotic and mechanical consequences.

A 77-year-old man undergoing preoperative coronary evaluation had left main bifurcation in-stent restenosis. Optical coherence tomography (OCT) showed well-apposed stents, fibrotic restenosis, and marked recoil despite repeated balloon dilatation; excimer laser coronary atherectomy was planned. Reassessment of the OCT pullback revealed a retained balloon catheter shaft extending from the left circumflex artery to the left main ostium, likely explaining refractory restenosis. Laser and cutting/scoring balloon strategies were considered unsafe. After heart team review, conservative management was selected because of prohibitive surgical risk.

This case highlights the role of OCT in clarifying percutaneous coronary intervention failure and identifying occult retained material before potentially harmful intervention.

When restenosis is resistant to balloon preparation, OCT should be reviewed for foreign material. Once endothelialized, retained devices may be difficult to retrieve, and nonintervention may be safest.