Balloon shaft fracture, deflation failure, and intracoronary entrapment: A stepwise percutaneous bailout – A case Report

Background Balloon catheter fracture during percutaneous coronary intervention (PCI) is rare but potentially catastrophic. The literature describes three distinct forms: shaft fracture, undeflatable balloon, and entrapped balloon. Published bailout strategies typically address each problem in isolation; however, no specific guidance exists when multiple forms occur simultaneously. Case summary A 62-year-old man with multivessel coronary disease underwent staged PCI of an a left circumflex–obtuse marginal bifurcation. During lesion preparation, a reused semi-compliant balloon (2.5 × 14 mm) fractured after multiple inflations, leaving an inflated, entrapped balloon fragment at the bifurcation with impaired antegrade flow. A stepwise percutaneous bailout was performed: (1) length comparison with an intact reference balloon suggested that a long fragment was partly retained inside the guiding catheter; (2) a guide extension catheter was advanced to displace the fragment distally, achieving passive deflation and restoring flow; and (3) the deflated fragment was retrieved using a 2.0 mm trapping balloon straddling the tip of the guiding catheter. The procedure was completed successfully with stenting, and the patient recovered uneventfully. Discussion Sequential management converted a high-risk situation into a tractable single problem. Distal displacement of the inflated fragment relieved ischaemia before any retrieval attempt was made. Trapping with a second balloon straddling the guide catheter tip may improve grip when the fragment partly protrudes from the guiding catheter.