01 Feb 2023
How to reduce the profile of an already inflated angioplasty balloon?
A problem-solving step by step tutorial
Decreasing the profile of a previously inflated angioplasty balloon helps a lot to re-use the balloon and improve the crossing of new lesions, or even to re-dilate previously-expanded stents. Watch this step by step tutorial provided by Ángel Nájera Albarrán to find out how!
Frequency of the problem:
Expert level:
Summary
Decreasing the profile of a previously inflated angioplasty balloon helps a lot to re-use the balloon and improve the crossing of new lesions, or even to re-dilate previously-expanded stents.
To do so, you must have the stylet and the balloon protector, which we will use to reduce the profile of an angioplasty balloon each time it is inflated.
The problem
On many occasions, we wish to re-use a previously-inflated angioplasty balloon to dilate new lesions, or even optimize lesions or stents. However, the profile of these lesions increases considerably compared to new ones, making it difficult and, in most cases, impossible to cross.
Principal idea
The basic idea is to reduce the profile of an already deployed balloon as much as possible by trying to bend it as much as possible to resemble its crossing profile when new. This is sometimes achieved by applying repeated negative pressure and folding with the fingers, but it is not enough.
Material needed
Any semi-compliant or non-compliant angioplasty balloon can be used. You will need also a balloon stylet and a protective sheath.
Method step-by-step
Step 1
Introduce protective sheath or re-wrapping sheath with stylet completely into the unfolded ballon.
Step 2
Breathe in 3 times at 10 atm for 5 seconds.
Step 3
Maintain negative pressure and remove sheath with stylet.
Step 4
Ready for next ballooning.
Points of specific attention
For some, especially large diameter balloons, it is recommended to bend it with negative pressure to be able to introduce it into the sheath. And to breathe in the nominal to improve the result.
It is important, after using a balloon, to facilitate the use of this technique, to clean by administering water through the rail.
A word from the reviewer - Julien Adjedj
Authors presented in this toolkit how to reshape an already inflated balloon for percutaneous coronary interventions. This technique and these videos are very useful in daily practice to use again a balloon. It is of importance especially in coronary bifurcation intervention for whom many steps of pre-dilatation, stent strut opening and post dilatation are frequent. This toolkit will reduce the cost of the procedure and facilitate coronary interventions.
Authors
4 comments
We usually make profile of balloon for 2nd time use . Inflate balloon at normal pressure in guide and look at pressure curve and if it become zero it means profile of balloon is updated and it also works some time but not always.
excelent!
If balloon has been expanded , at times it is difficult to push through the protective sleeve which comes with balloon catheter. We use a straightener which comes with J tip 0.35” Teflon coated routine guide wires. On the same wire or 0.014” PTCA wire which already in the system. Advance the balloon within the straightner and inflate upto 1-2 atmp pressure. While deflating balloon , at the same time start rotating balloon over the wire shaft and take out from the straightener sheeth , on can further smoothen it with your thumb and index finger and balloon is ready with low profile, rewrapped . Very effective.
this is the great way to save money by utilizing the same balloon which is already opened and used. and i have great experience of its use in side branch crossing specially when side branch is crossed over