Ruptured and Trapped: Balloon dissection of left main coronary artery successfully managed with bail-out stenting – A Case report

Background Abrupt left main coronary artery closure from ruptured balloon during percutaneous coronary intervention is rare and can be catastrophic. A comprehensive knowledge of the various bailout techniques in such situations can be lifesaving. We describe a case of abrupt left main vessel closure leading to hemodynamic instability and the techniques employed for a prompt and successful revascularization. Case summary A 74-year-old gentleman who presented with effort angina. His trans-radial coronary angiogram revealed significant left main coronary artery (LMCA) stenosis with triple vessel disease. While attempting to prepare the left circumflex artery lesion with balloon dilatation, balloon rupture led to retrograde LMCA dissection with abrupt vessel closure and hemodynamic instability. Subsequently, bailout stenting from LMCA to left anterior descending artery was done followed by TAP stenting (T And small Protrusion) to LCX, thereby compressing the remanent balloon fragment against the vessel wall of the LCx (crush technique) and achieving TIMI III (Thrombolysis in Myocardial Infarction) flow. Discussion This case highlights the catastrophic complication of abrupt LMCA closure with remanent balloon fragment that may occur with balloon rupture. Recognizing the various factors that lead to balloon rupture is important. Establishing LMCA perfusion while maintaining hemodynamics should be the primary goal in patients with acute LMCA occlusion. Bail out stenting decreases the time lapse and subsequent prolonged ischemia with worsening LV function compared to CABG.