Multiple coronary artery perforation as a fatal complication during the management of an undeflatable stent balloon: a case report

TL;DR

A rare complication during heart stent placement led to a balloon being stuck, causing severe artery damage despite attempts to remove it.

Contribution

This case report highlights the risks of inflating an undeflatable balloon beyond its limit during PCI as a last-resort solution.

Findings

An undeflatable stent balloon led to multiple coronary perforations after being inflated beyond its burst pressure.

Covered stents were used to successfully seal the perforations.

The case emphasizes the need for preparedness when using last-resort strategies for PCI complications.

Abstract

An undeflatable stent balloon following its inflation during percutaneous coronary intervention (PCI) is a rare and unpredictable complication that can lead to serious consequences. Currently, there is no standardized protocol for managing this issue.

An 83-year-old man presented with chest pain. Coronary angiography showed a chronic total occlusion (CTO)-like lesion in the proximal left anterior descending coronary artery (LAD). Following stent deployment, the balloon failed to deflate and remained inflated within the LAD. Despite multiple retrieval attempts, the issue remained unresolved. As an alternative to surgical removal, we inflated the balloon beyond its rated burst pressure within the coronary artery. The balloon eventually ruptured and was successfully retrieved; However, this resulted in multiple severe coronary perforations, which were effectively sealed using covered stents.

Balloon deflation failure is an exceptionally rare, unpredictable, and critical complication of PCI. While various troubleshooting strategies exist, inflating an undeflatable balloon beyond its burst pressure should be considered only as a last resort, with thorough preparation for potential complications.

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