Abstract
Introduction: Device entrapment during PCI is an uncommon complication with incidence of less than 1%. Percutaneous retrieval should be favored as the treatment of choice for this condition. Case Illustration: A 61-year-old patient came for an elective percutaneous coronary intervention (PCI) procedure. She suffered from chest pain while doing moderate activities for 1 month. Angiography showed a diffuse lesion with maximum stenosis 90% in the proximal LAD, stenosis 75% in the proximal of Left Circumflex Artery (LCx), and diffuse lesions in the proximal and mid of the Right Coronary Artery (RCA). We decided to perform PCI in the LAD. A transfemoral coronary intervention was performed using a Judkins Left 3.5 (7F) guiding catheter to engage the LAD. A Guidewire ( Run-through NS Floppy) was advanced to the distal LAD. Balloon angioplasty was performed with a 2.75 x 15 mm Fluydo balloon in the proximal LAD at 16 bars, but the balloon was entrapped and while withdrawing the balloon, it accidentally ruptured in the LAD artery with the remaining segment inside the guiding catheter. A second Run-through NS Floppy Guidewire was inserted across the ruptured balloon and a 2.5 x 20 mm Fluydo Balloon was passed on the second wire and was inflated at 16 atm pressure, inside the guiding catheter, trapping the ruptured balloon. The ruptured balloon was successfully removed, by withdrawing the whole system, including the guiding catheter and the wire. Finally, we re-engaged the LAD with the same guiding catheter, passed the wire, and post dilated the stent on the LAD to achieve a good result. Conclusion: Percutaneous retrieval using trapping technique could represent a safe and effective technique for ruptured and entrapment of a balloon-catheter in a coronary artery.
Highlights
Device entrapment during percutaneous coronary intervention (PCI) is an uncommon complication with incidence of less than 1%
Balloon angioplasty was performed with a 2.75 x mm Fluydo balloon in the proximal LAD at bars, but the balloon was entrapped and while withdrawing the balloon, it accidentally ruptured in the LAD artery with the remaining segment inside the guiding catheter
A second Run-through NS Floppy Guidewire was inserted across the ruptured balloon and a 2.5 x 20 mm Fluydo Balloon was passed on the second wire and was inflated at 16 atm pressure, inside the guiding catheter, trapping the ruptured balloon
Summary
Percutaneous coronary intervention (PCI) is a relatively safe procedure for the relief of ischaemic symptoms due to coronary artery disease.[1]. With the increasing prevalence of percutaneous coronary intervention (PCI) and complexity of lesion, even rare complications such as hardware-related complications such as stent fracture, broken coronary balloons, guidewires, guiding catheter, and other hardware, are increasingly reported and becoming a serious problem.[2,3] Various non-surgical procedures have been proposed for the retrieval of broken hardware in the PCI procedure.[3]
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