CONGRESS ABSTRACT

Background: Percutaneous coronary intervention (PCI) is a cornerstone in the treatment of ischemic heart disease. Despite continuous technological advances, PCI may still be complicated by rare but potentially severe procedural events. Balloon catheter rupture is an uncommon complication that can lead to coronary dissection, perforation, thrombosis, gas embolism, and device entrapment, with possible hemodynamic compromise. Prompt recognition and mastery of bailout techniques are therefore essential. We report a rare case of multi-fragmented balloon catheter shaft rupture occurring during bifurcation PCI. Case Description and Technical Resolution : A 71-year-old man with multiple cardiovascular risk factors presented with a one-month history of angina. Myocardial perfusion scintigraphy demonstrated significant inducible ischemia involving the anterior and inferolateral walls. Coronary angiography revealed multivessel disease involving the right coronary artery and the left anterior descending artery (LAD). PCI of the right coronary artery was successfully performed with drug-eluting stent (DES) implantation, followed by PCI of the LAD with distal balloon angioplasty and implantation of three DES in the mid segment. Post-procedural ischemia due to significant ostial stenosis of the jailed diagonal branch required proximal optimization technique, side-branch rewiring, and kissing balloon inflation with non-compliant balloons. During this phase, an unexpected multi- fragmented rupture of the balloon catheter shaft occurred within the LAD (Figure 1). The fragments were promptly retrieved using a dedicated snare device, achieving complete removal without distal embolization (Figure 2). Subsequent angiography revealed a proximal LAD dissection, which was successfully treated with additional DES implantation. Final angiography demonstrated optimal results with restoration of TIMI 3 flow and no residual complications (Figure 3). Clinical Implications and Perspectives: This case shows that balloon rupture, although rare, can occur during routine PCI. Prompt recognition, operator expertise with retrieval devices, and timely management of associated complications are essential for procedural success and patient safety. Adequate training, planning, and access to bailout devices remain key to managing unexpected mechanical failures in complex PCI.