Pinhole balloon rupture and stuck stent: case report of a new and simple bailout technique for incomplete stent dilatati
- PDF / 882,393 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 184 Views
CASE REPORT
Pinhole balloon rupture and stuck stent: case report of a new and simple bailout technique for incomplete stent dilatation caused by rupture from a highly calcified lesion Fumiyo Tsunoda • Kinya Shirota • Yoshiaki Inoue • Hiroshige Ishii • Shinobu Sugihara • Asao Mimura
Received: 17 December 2013 / Accepted: 25 January 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract We report a case of highly calcified 75 % stenotic lesion in the proximal left anterior descending coronary artery. During stenting, the balloon incurred a pinhole rupture at the moment of dilatation and the stent expanded only at both ends. This caused the balloon and stent to become lodged in the coronary artery. An attempt to dilate the balloon using rapid inflation alone was not successful, but we succeeded in dilating the stent with rapid balloon inflation by increasing the concentration of the contrast medium. We confirmed the occurrence of this phenomenon in vitro. Keywords Highly calcified lesion Stuck balloon Pinhole rupture
Introduction Pinhole rupture of a balloon sometimes occurs during catheter treatment of highly calcified coronary artery lesions. Once pinhole rupture of the stent balloon occurs, the stent usually expands incompletely and cannot be easily withdrawn into the guide catheter. We report a new and simple bailout technique for incomplete stent dilatation caused by pinhole balloon rupture.
F. Tsunoda (&) K. Shirota Y. Inoue H. Ishii S. Sugihara A. Mimura Division of Cardiology, Matsue Red Cross Hospital, 200 Horo-machi, Matsue, Shimane, Japan e-mail: [email protected]
Case presentation A 72-year-old man with dyslipidemia had been treated for angina at his local hospital with percutaneous coronary intervention (PCI) of the mid left anterior descending (LAD) artery in December 1997 and another PCI in April 1998 for restenosis of the lesion. He was referred to our hospital for exercise-induced chest tightness at the end of November 2011 and was admitted in early December. Coronary angiography showed a highly calcified 75 % stenotic lesion in the proximal LAD and a 100 % lesion in the distal right coronary artery (Fig. 1a–c). We performed a staged PCI via the right brachial artery using a 6-Fr guide catheter (RadiguideÒ II IL-3.5; Terumo, Tokyo, Japan). Intracoronary heparin (8,000 units) was administered, and a RunthroughÒ NS Extra Floppy PTCA Guide Wire (Terumo, Tokyo, Japan) was advanced into the LAD. The target lesion was observed using intravascular ultrasound (IVUS) (Atlantis catheter, Boston Scientific Japan K.K.; Tokyo, Japan) (Fig. 1d, e), and diffuse calcification was seen. After pre-dilatation with a 3.0 9 20mm balloon (Quantum ApexTM; Boston Scientific, Tokyo, Japan), we were unable to pass a 3.5 9 24-mm stent (Nobori; Terumo, Tokyo, Japan) using an ULTIMATEbros3 PTCA Guide Wire (Asahi Intecc; Aichi, Japan). We then set up a 5-Fr guiding catheter (Heartrail ST01; Terumo, Tokyo, Japan) within a 6-Fr guiding catheter in a mother–child catheter con
Data Loading...
