Intravascular Lithotripsy Balloon Entrapped in Right Coronary Artery Requiring Surgical Bailout

A clinical case of an entrapped intravascular lithotripsy (IVL) balloon, requiring surgical bailout.

A 72-year-old gentleman presented with a non-ST-segment elevation myocardial infarction. A severe mid right coronary artery calcific lesion was the culprit. We attempted to treat this with percutaneous coronary intervention using IVL. After completion of IVL therapy, the balloon was unable to be freed. All strategies to free the balloon were unsuccessful (a 3-wire wrap, inflating a balloon in parallel and snaring). The patient was sent for emergency coronary artery bypass graft surgery. The IVL balloon could not be freed by the surgeon and so was left cut at the ostium.

To our knowledge, this is the only such case report highlighting an entrapped IVL balloon, requiring surgical bailout.

Our learning from this case is that when using IVL, resistance to crossing should prompt reassessment of calcium modification strategy rather than continued forceful advancement.