Bailout Retrieval of a Ruptured Entrapped Coronary Balloon Using the Reinflation-Deflation Technique (Nantapon-Wittawat Technique)

Balloon rupture with subsequent device entrapment during percutaneous coronary intervention (PCI) is an uncommon but potentially life-threatening complication, particularly in heavily calcified coronary lesions.Management is technically challenging, and no standardized bailout strategy has been established.We report a successful bailout reinflation-deflation maneuver, termed the Nantapon-Wittawat Technique (NWT), for retrieval of a ruptured entrapped coronary balloon during primary PCI.We describe the case of a 65-year-old man with hypertension who presented with acute anterior ST-segment elevation myocardial infarction (STEMI) complicated by ischemic right bundle branch block.Emergency coronary angiography revealed a heavily calcified proximal-to-mid left anterior descending artery (LAD) with total occlusion.During lesion preparation, a non-compliant balloon ruptured and became entrapped within the calcified LAD.Conventional bailout options, including buddy wire, buddy balloon, guide-extension catheter, and emergency surgery, were considered.However, because of progressive hemodynamic deterioration, a bailout maneuver -the Nantapon-Wittawat Technique -was performed.The technique consisted of controlled lowpressure reinflation of the ruptured balloon followed by gradual deflation to restore balloon morphology before gentle withdrawal.The entrapped balloon was successfully retrieved without coronary perforation, dissection, or retained balloon fragments.Definitive PCI was subsequently completed with drug-eluting stent implantation, restoring antegrade coronary flow.The reinflation-deflation technique (Nantapon-Wittawat technique) may represent a feasible bailout maneuver for selected cases of ruptured balloon entrapment during PCI.However, its safety, efficacy, and reproducibility remain uncertain and require validation in additional clinical experience.Although further clinical validation is warranted, this technique expands the spectrum of percutaneous rescue strategies and offers a practical technical insight for managing this rare but challenging PCI complication.