Balloon shaft fracture, deflation failure, and intracoronary entrapment: A stepwise percutaneous bailout – A case Report

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ID: 337471
2026
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Abstract
Abstract Background Balloon catheter fracture during percutaneous coronary intervention (PCI) is rare but potentially catastrophic. The literature describes three distinct forms: shaft fracture, undeflatable balloon, and entrapped balloon. Published bailout strategies typically address each problem in isolation; however, no specific guidance exists when multiple forms occur simultaneously. Case summary A 62-year-old man with multivessel coronary disease underwent staged PCI of an a left circumflex–obtuse marginal bifurcation. During lesion preparation, a reused semi-compliant balloon (2.5 × 14 mm) fractured after multiple inflations, leaving an inflated, entrapped balloon fragment at the bifurcation with impaired antegrade flow. A stepwise percutaneous bailout was performed: (1) length comparison with an intact reference balloon suggested that a long fragment was partly retained inside the guiding catheter; (2) a guide extension catheter was advanced to displace the fragment distally, achieving passive deflation and restoring flow; and (3) the deflated fragment was retrieved using a 2.0 mm trapping balloon straddling the tip of the guiding catheter. The procedure was completed successfully with stenting, and the patient recovered uneventfully. Discussion Sequential management converted a high-risk situation into a tractable single problem. Distal displacement of the inflated fragment relieved ischaemia before any retrieval attempt was made. Trapping with a second balloon straddling the guide catheter tip may improve grip when the fragment partly protrudes from the guiding catheter.
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Authors Anh Do Nguyen, Phan Tiến Hóa, D. Chau
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag804
URL
https://doi.org/10.1093/ehjcr/ytag804
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