Pinhole balloon rupture and stuck stent: case report of a new and simple bailout technique for incomplete stent dilatation caused by rupture from a highly calcified lesion

Abstract

We report a case of highly calcified 75% stenotic lesion in the proximal left anterior descending coronary artery. During stenting, the balloon incurred a pinhole rupture at the moment of dilatation and the stent expanded only at both ends. This caused the balloon and stent to become lodged in the coronary artery. An attempt to dilate the balloon using rapid inflation alone was not successful, but we succeeded in dilating the stent with rapid balloon inflation by increasing the concentration of the contrast medium. We confirmed the occurrence of this phenomenon in vitro.

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

“…The burst, especially when the balloon ruptures in a pin-hole tear, may cause vascular trauma, including local dissection, perforation, and intramural hematoma [5]. A circumferential tear may be associated with detachment of device components [3,6]. By design, and as presented in this case, the balloon tends to rupture in a longitudinal tear, which is less often associated with complications.…”

“…Balloon rupture is a potentially lethal complication of angioplasty procedures [2,3]. Available data on incidence are outdated [4].…”

Management of balloon rupture during a percutaneous pulmonary valve implantation procedure

“…Albeit rarely, pinhole rupture of a balloon has been described to occur during catheter treatment of highly calcified coronary artery lesions, causing incomplete stent expansion. A case report delineated how this problem was overcome inflating the balloon with a higher concentration of contrast medium 6 . In our case, the balloon defect was possibly caused by re-inserting the spindle into the balloon catheter to give a higher support to the balloon when mounting the stent or by stent edge while being crimped.…”

A Rare Complication of Stent Implantation: Aortocoronary Dissection

“…Rarely, dissection involving the aortic root may also develop, and these large coronary artery dissections may cause acute coronary artery occlusion, resulting in myocardial infarction and even death (2,3) . Although it is relatively more common during balloon angioplasty of calcified plaques at high inflation pressures, in the literature, there are only two cases of pin hole rupture during stent implantation of heavily calcified lesions (4,5) . Here we present the case of a 51-year-old male who experienced stent balloon rupture at normal inflation pressure, causing retrograde coronary and aortic dissection, in addition to stent underexpansion at non-calcified thrombotic total occlusion of the proximal segment of the right coronary artery (RCA).…”