Author + information
- Received July 6, 2016
- Accepted July 18, 2016
- Published online October 10, 2016.
- Yoshiyasu Minami, MD, PhD∗ (, )
- Kentaro Meguro, MD, PhD,
- Takao Shimohama, MD, PhD,
- Tomoyoshi Yanagisawa, MD, PhD,
- Ryota Kakizaki, MD,
- Taiki Tojo, MD, PhD and
- Junya Ako, MD, PhD
- ↵∗Reprint requests and correspondence:
Dr. Yoshiyasu Minami, Division of Cardiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan.
A 75-year-old woman underwent percutaneous coronary intervention (PCI) for her tight calcified lesion at proximal left anterior descending artery (Figure 1A). After debulking the thick calcified lesion using rotational coronary atherectomy, further dilation using a noncompliant balloon was attempted. However, the lesion was too rigid to expand resulting in balloon rupture. When retracting the balloon, the ruptured balloon fractured in the middle. The distal portion of the balloon was left behind, trapped between the lesion and the tip of the guiding catheter. Angiography and intravascular ultrasound images of the left main artery (Figure 1B) failed to identify the location of remaining balloon; therefore, we performed optical coherence tomography (OCT). The structure of remaining balloon was clearly visualized by OCT (Figures 1C to 1F). Because a part of balloon was already inside the guiding catheter, we captured it by dilating another balloon inside the catheter. The ruptured balloon was successfully retrieved by withdrawing the whole system, including the guiding catheter and the coronary wires (Figure 1G).
Herein, we report successful retrieval of entrapped ruptured balloon under OCT guidance. Device entrapment during PCI is a rare but a serious complication (1) that may lead to adverse events including intracoronary thrombus formation and emergent coronary artery bypass grafting (2). It is utmost importance to accurately locate the intracoronary foreign body for safe retrieval (3). In this case, it was impossible to detect the remaining balloon on angiography because the x-ray marker was stretched and nearly invisible. In addition, the remaining balloon was not imaged by intravascular ultrasound while the whole structure of the remaining balloon was clearly imaged by OCT, owing to the superior spatial resolution. OCT is a powerful option to accomplish safe bailout in device entrapment during PCI.
Dr. Ako has received lecture fees from St. Jude Medical, Volcano, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2016.
- Accepted July 18, 2016.
- American College of Cardiology Foundation