Atherotome Dislodgement and Successful Retrieval During Cutting Balloon Pulmonary Angioplasty

Abstract

Cutting balloons (CBs) are beneficial for dilation of resistant branch pulmonary artery (PA) stenosis in children.1 There are rare reports of atherotome fracture2 and a Food and Drug Administration adverse event report of a fractured atherotome dislodging and remaining in the patient.3 We report CB atherotome dislodgement and embolization with successful retrieval in a patient with Alagille syndrome and branch PA stenosis. A 7-year-old girl with Alagille syndrome, systemic hypertension, branch PA stenosis, and a small patent ductus arteriosus was referred for left PA dilation and percutaneous patent ductus arteriosus closure to optimize her cardiac status before liver transplantation. Angiograms of the left PA demonstrated stenosis of the proximal left lower PA (LLPA) measuring 3.07 mm, with the distal LLPA measuring 6.2 mm. An 8-mm balloon (Sterling; Boston Scientific) was inflated to 8 atm with a 6-mm waist (Figure 1). Through a 7F long sheath (Check-Flo Performer Introducer, Mullins Design; …