Successful Retrieval of Entrapped Balloon With Optical Coherence Tomography Guidance

JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 9, NO. 19, 2016

ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-8798/$36.00

PUBLISHED BY ELSEVIER

http://dx.doi.org/10.1016/j.jcin.2016.07.029

Successful Retrieval of Entrapped Balloon With Optical Coherence Tomography Guidance Yoshiyasu Minami, MD, PHD, Kentaro Meguro, MD, PHD, Takao Shimohama, MD, PHD, Tomoyoshi Yanagisawa, MD, PHD, Ryota Kakizaki, MD, Taiki Tojo, MD, PHD, Junya Ako, MD, PHD

A

75-year-old woman underwent percutaneous

Herein, we report successful retrieval of entrapped

coronary intervention (PCI) for her tight calci-

ruptured

fied lesion at proximal left anterior descend-

entrapment during PCI is a rare but a serious

balloon

under

OCT

guidance.

Device

ing artery (Figure 1A). After debulking the thick

complication (1) that may lead to adverse events

calcified lesion using rotational coronary atherec-

including intracoronary thrombus formation and

tomy, further dilation using a noncompliant balloon

emergent coronary artery bypass grafting (2). It is

was attempted. However, the lesion was too rigid to

utmost importance to accurately locate the intra-

expand resulting in balloon rupture. When retracting

coronary foreign body for safe retrieval (3). In this

the balloon, the ruptured balloon fractured in the

case, it was impossible to detect the remaining

middle. The distal portion of the balloon was left

balloon on angiography because the x-ray marker was

behind, trapped between the lesion and the tip of

stretched and nearly invisible. In addition, the

the guiding catheter. Angiography and intravascular

remaining balloon was not imaged by intravascular

ultrasound images of the left main artery (Figure 1B)

ultrasound while the whole structure of the remain-

failed to identify the location of remaining balloon;

ing balloon was clearly imaged by OCT, owing to the

therefore, we performed optical coherence tomogra-

superior spatial resolution. OCT is a powerful option

phy (OCT). The structure of remaining balloon was

to accomplish safe bailout in device entrapment

clearly visualized by OCT (Figures 1C to 1F). Because

during PCI.

a part of balloon was already inside the guiding catheter, we captured it by dilating another balloon

REPRINT REQUESTS AND CORRESPONDENCE: Dr.

inside the catheter. The ruptured balloon was success-

Yoshiyasu Minami, Division of Cardiology, Kitasato

fully retrieved by withdrawing the whole system,

University

including the guiding catheter and the coronary wires

Sagamihara

(Figure 1G).

yahoo.co.jp.

Hospital, 252-0375,

1-15-1

Kitasato,

Japan.

E-mail:

From the Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan. Dr. Ako has received lecture fees from St. Jude Medical, Volcano, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received July 6, 2016; accepted July 18, 2016.

Minami-ku, nrg12391@

Minami et al.

JACC: CARDIOVASCULAR INTERVENTIONS VOL. 9, NO. 19, 2016 OCTOBER 10, 2016:2070–1

OCT-Guided Entrapped Balloon Retrieval

F I G U R E 1 Images of Entrapped Balloon on Angiography, IVUS, and OCT

(A) Angiography revealed tight lesion (arrow) at proximal left anterior descending artery. (B) The remaining balloon was not visualized by intravascular ultrasound. (C, D) Optical coherence tomography (OCT) clearly imaged the remaining balloon (arrow) within the left main artery and guiding catheter. The asterisk represents residual red blood cells. (E, F) Three-dimensional and longitudinal reconstructed OCT images demonstrated an abnormal ductal mass (arrow) over the tip of guiding catheter (asterisk). Dotted lines represent the location of crosssectional OCT images in C and D. (G) The removed balloon, which shrunk during the retrieval (asterisk). The x-ray marker was stretched (arrow) and nearly invisible on angiography.

REFERENCES 1. Brilakis ES, Best PJ, Elesber AA, et al. Incidence, retrieval methods, and outcomes of stent loss during percutaneous coronary intervention: a large single-center experience. Catheter Cardiovasc Interv 2005;66:333–40. 2. Alexiou K, Kappert U, Knaut M, Matschke K, Tugtekin SM. Entrapped coronary

catheter remnants and stents: must they be surgically removed? Tex Heart Inst J 2006;33: 139–42. 3. Madronero JL, Hein F, Bergbauer M. Removal of a ruptured, detached, and entrapped angioplasty balloon after coronary stenting. J Invasive Cardiol 2000;12:102–4.

KEY WORDS bail out, balloon rupture, optical coherence tomography

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