# Balloon Uncrossable Left Main Coronary Artery Dissection: A Case Report and Literature Review

## TL;DR

A complex case of a calcified coronary artery dissection is reported, highlighting innovative techniques and teamwork in managing challenging heart procedures.

## Contribution

A novel technique using a semi-compliant balloon during deflation to cross a calcified lesion is described.

## Key findings

- A balloon-uncrossable lesion in a calcified LAD artery was successfully managed with a novel balloon advancement technique.
- Multidisciplinary consultation and innovative approaches improved outcomes in a high-risk coronary intervention.
- Optimized stent deployment and post-dilatation resulted in stable patient recovery and good angiographic results.

## Abstract

Coronary artery dissection presents a high‐risk scenario, particularly when complicated by severe calcification. We report a complex case of a balloon‐uncrossable lesion encountered during percutaneous coronary intervention (PCI) of a calcified ostial‐to‐mid left anterior descending (LAD) artery lesion extending into the LMCA. A 54‐year‐old male with type 2 diabetes and exertional angina underwent coronary angiography revealing severe calcified LAD disease. Despite successful initial balloon pre‐dilatation, a drug‐eluting stent (DES) could not cross the lesion. Withdrawal attempts resulted in a large LMCA‐to‐LAD dissection flap, preventing further device passage. Urgent multidisciplinary consultation was initiated. A novel approach using forceful advancement of a 1.0 mm semi‐compliant balloon during deflation enabled successful lesion crossing. This was followed by lesion preparation, overlapping DES deployment, and optimized post‐dilatation. The patient remained stable, with excellent angiographic results. This case underscores the importance of innovation and teamwork in managing complex, calcified coronary lesions with unexpected procedural complications.