Case study: primary PCI of left main coronary artery to LAD stenting with retrieval of broken NC balloon shaft

Clinical presentation

• 53-year-old female known diabetic presented with chest pain, retrosternal burning associated with radiating to left arm on and off since 3 days
• CAD-AWMI
• Troponin I-3.29ng/ml
• 2D Echo-moderate LV dysfunction-EF 48%
• CAG-SVD

Coronary angiogram

CAG-LCX Anamolus origin arising from right sinus

CAG-LCX Anamolus origin arising from right sinus

CAG-LAD Proximal 99% lesion

CAG-LAD Proximal 99% lesion

Procedure

LAD Lesion crossed with 0.014 X 190cms" Sion Blue wire. D1 crossed with 0.014" Versaturn wire

LAD Lesion crossed with 0.014 X 190cms" Sion Blue wire. D1 crossed with 0.014" Versaturn wire

Pre-dilatation done with 1.5 X 10 mm Tazuna balloon

Pre-dilatation done with 1.5 X 10 mm Tazuna balloon

RAMUS wire / LMCA to LAD stenting done with 3.0 x 30mm Orsiro stent

RAMUS wire / LMCA to LAD stenting done with 3.0 x 30mm Orsiro stent

Consult the editorial webcast of this clinical case from the EuroPCR 2018 session on Balloon catheter complications

Unable to withdraw balloon wire to broken shaft to NC balloon. Placement of another 2.5mm new balloon in to the catheter just keeping proximal to the broken NC balloon. Inflated balloon and catheter assembly was withdraw and patient developed on going chest pain, hypotension and ST-elevation which was reversed after pulling the broken balloon shaft from LMCA.

Balloon tracking of guide catheter

Balloon tracking of guide catheter

Rewire

Rewire

Post dilatation done with 3.5 x 12mm NC Trek balloon

Post dilatation done with 3.5 x 12mm NC Trek balloon

POT

POT

Final angiographic result