Author + information
- Received June 26, 2015
- Accepted July 21, 2015
- Published online December 21, 2015.
- Jonathan Watt, MB ChB, MD∗ (, )
- Ayush Khurana, MB ChB,
- Javed M. Ahmed, MBBS and
- Ian F. Purcell, MB ChB, MD
- ↵∗Reprint requests and correspondence:
Dr. Jonathan Watt, Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, United Kingdom.
A 52-year-old woman with uncontrolled angina underwent coronary angiography, which showed stenosis of the left anterior descending and first diagonal bifurcation (Figure 1A). Culotte stenting was performed using a 2.5 mm × 18 mm Xience ProX drug-eluting stent (Abbott Vascular, Abbott Park, Illinois) in the diagonal, followed by a 3.5 mm × 18 mm Xience Prime drug-eluting stent (Abbott Vascular) in the left anterior descending artery. However, it was impossible to deflate the stent balloon using the indeflator. The undeflatable stent balloon completely obstructed the distal left main stem (Figure 1B). No defect was visible in the stent assembly. The patient developed severe chest pain and hypotension, and was treated for ventricular fibrillation. We could not burst the balloon using a Confianza Pro 12 guidewire (Asahi Intecc Co., Aichi, Japan) or by overinflating to 28 atm. The stuck balloon was unresponsive to significant pulling. Finally, we cut the hypotube using sterile scissors (Figure 1C), optimizing the patency of the lumen using the stiff end of a coronary guidewire. The balloon passively deflated and was removed. The total inflation time was 21 min. Kissing balloon dilation was performed, and a good final result was achieved. Peak troponin T was 80 ng/l (normal range 0 to 14 ng/l). Echocardiography was normal. We believe an undeflatable angioplasty balloon is most likely caused by an invisible kink in the metallic hypotube near the plastic attachment, which allows positive pressure inflation but not negative pressure deflation. Therefore, our simple solution, hitherto unpublished, should be strongly considered to avert a potentially fatal outcome.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 26, 2015.
- Accepted July 21, 2015.
- American College of Cardiology Foundation