Entrapped coronary balloon with shaft disruption during LAD PCI requiring emergency surgical extraction: a case...

Entrapment of an undeflated angioplasty balloon with subsequent shaft disruption is a rare, life-threatening complication of percutaneous coronary intervention (PCI). When percutaneous retrieval fails, emergency surgical extraction with concomitant revascularization may be the only lifesaving option. Shaft disruption of a non-deflating angioplasty balloon represents an exceptionally rare subset of PCI device entrapment, with only isolated cases reported in the literature. A 76-year-old hypertensive and diabetic woman presented with a 5-day history of exertional dyspnea, palpitations, and generalized fatigue. Diagnostic coronary angiography revealed triple-vessel coronary artery disease involving distal left main, proximal left anterior descending artery (LAD), ramus, left circumflex (LCx), and right coronary artery (RCA). She underwent multivessel PCI. LCx and ramus were stented uneventfully. During attempted LAD lesion preparation, the dilatation balloon failed to deflate; the distal tip collapsed while the proximal segment remained inflated; a stent was therefore never deployed in the LAD. Attempts to withdraw the balloon led to shaft fracture, with the partially inflated balloon retained in the LAD and guidewire fragment prolapsing into the aorta. Multiple retrieval maneuvers with fresh guidewires failed and hemodynamics deteriorated despite intra-aortic balloon pump (IABP) and dual inotropic support. Emergency surgery revealed hemorrhagic pericardial effusion and a hematoma along the proximal LAD. Under cardiopulmonary bypass (CPB), an oblique aortotomy exposed the guidewire exiting the left coronary ostium. The retained wire (≈25 cm) and inflated 2-cm balloon were extracted en bloc. Two reversed saphenous vein grafts (rSVGs) were placed to mid-LAD and posterior descending artery (PDA). The patient was weaned off bypass uneventfully and discharged on postoperative day 6. Entrapment of an undeflatable balloon during LAD PCI with shaft disruption is exceedingly rare. Early recognition, prompt surgical conversion, and complete revascularization are crucial for survival in this high-risk complication.