Coronary artery dilatation requiring high inflation pressure

Abstract

A patient with rigid coronary lesions refractory to balloon dilatation is described. A Cordis Orion fixed wire balloon able to withstand 20 bar was required for successful dilatation.

Management of resistant coronary lesions by the cutting balloon catheter: Initial experience

“…Usual strategies to dilate resistant lesions include longer inflations, higher inflation pressures and larger balloon diameters [13,14]. Whether high-pressure inflations are associated with more complications is somewhat controversial.…”

Balloon rupture complication

“…Despite the thinness of the wall a PET balloon can achieve higher inflation pressures while maintaining nominal size [3]. Finally, with the advent of noncompliant balloons with a higher burst pressure for use in unyielding stenosis [4,5], the impetus to use them frequently in unyielding lesions may be greater. A word of caution would be in order, namely that efforts in obtaining complete balloon dilatation and optimal results ought to be tempered by the fact that these unyielding lesions may in fact be calcified-since in calcified lesions, incomplete balloon expansion may occur despite high and prolonged inflation pressure [6]-and therefore associated with a higher rupture rate.…”

“…The use of resting flow parameters alone to assess local epicardial flow obstruction must take perfusion pressure into account. A sensible pressure flow approach has been proposed by Sermys et al [4]. We would like to report a case where balloon rupture and parachute snagging of the balloon in a calcified left anterior descending artery resulted in a loss of the the distal half of the balloon as well as left main dissection.…”