A Case of Balloon Rupture During Coronary Angioplasty: Slow Flow Requiring Swift Action

Abstract

We describe the case of a middle-aged man undergoing three-vessel coronary angioplasty due to unstable angina. Attempt to predilate a calcified lesion in the left circumflex artery with a semi-compliant balloon, inflated above the rated burst pressure, resulted in balloon rupture. Subsequently, the patient developed ST elevations and became hemodynamically unstable; slow flow in the index vessel was noted. The complication was managed with vasopressor and respiratory support, plus forceful injections of warm saline. Thrombolysis in myocardial infarction (TIMI)-3 flow was eventually restored, and the rest of the procedure was completed uneventfully. Following retrieval of the device, a longitudinal tear in the balloon was observed. This mode of rupture is considered to be safer, when compared to circumferential or pin-hole rupture. Rupture can occur when a balloon is aggressively inflated above nominal pressures and against calcific lesions. The ensuing micro-and macrovascular complications, including slowflow, no-reflow, vessel dissection or perforation, and intramural hematoma, may induce myocardial ischemia and ultimately cardiogenic shock, malignant arrhythmias, and cardiac arrest. Management should be swift, and relies on supportive measures, depending on the degree of complications caused by the rupture.

Shockwaves delivery for aortic valve therapy—Realistic perspective for clinical translation?

“…The sonic waves are transmitted from the balloon-based catheter to the vascular wall by physical contact to reach the media of the vessels, where they break more superficial or deeper calcium deposits, allowing optimal artery expansion and stent implantation. In the clinical practice, IVL has been successfully employed in balloon angioplasty and plaque ablation and as an adjuvant to prevent post-procedure complications, such as accelerated restenosis, damage of the arterial wall, or catheter overstretching and rupture (36)(37)(38)(39). In a trial by Tepe et al, the authors tested the efficiency of IVL on percutaneous transluminal angioplasty (PTA) in two cohorts of patients with femoropopliteal artery calcification (40).…”

Erroneous Rapid Exchange Balloon Inflation During Coronary Angioplasty in a Male Patient in His 70s With Chronic Stable Angina

“…The erroneous inflation was probably due to improper gluing of the proximal end of the balloon to the shaft (Figure, B). Coronary balloon-related complications like rupture and entrapment have been described in the literature, but dilatation of the glued part of the balloon has not, to our knowledge, been reported …”