The Undeflatable Balloon

The Undeflatable Balloon

Dr. David LO

United Christian Hospital, Hong Kong

A 59 years old gentleman was presented with acute inferior STEMI for primary PCI. The diagnostic angiography with right radial artery approach showed mild disease in LAD/LCX and total occlusion in proximal RCA (Figure 1). Right coronary artery was engaged with JR4 catheter. After successful wiring, manual thrombus aspiration and POBA were performed. The angiogram and IVUS after POBA showed severe stenosis and clots in mid RCA with size discrepancy between proximal and mid segment (Figure 2).

Stentys (Self expansible stent) was positioned in proximal to mid right coronary artery (Figure 3), however it could not be deflated after full expansion (Figure 4). The design of Stentys with the splitable sheath precludes the use of stiff wire or cut end ST01 mother and child catheter to puncture the balloon (Figure 5). The operator decided to pull the undeflated stent balloon out into aorta. However, with forceful pulling the shaft of the stent balloon was broken. The distal shaft was still inside the guiding catheter. Trapping balloon technique was used and the stent balloon was successfully pulled out to aorta (Figure 6, Figure 7).

With right femoral approach, PCI to RCA was completed with deployment of one more stent in mid RCA followed by post dilatation. The final angiography was satisfactory (Figure 8). The guiding catheter, undeflated balloon and wire were enbloc removed out of the body along with the radial sheath (Movie 1, Figure 9).

Lesson to learn:

Great caution in handling stent to prevent kinking in the stent balloon shaft especially pulling out from plastic hub that may result in undeflatable stent balloon.

Early use of trapping balloon to prevent broken of stent shaft if forceful pulling is needed.