Reverse Balloon Anchoring for Retrieval of an Entrapped Side‐Branch Balloon During the Jailed Balloon Technique

The jailed balloon technique (JBT) is an effective strategy for side branch (SB) protection during percutaneous coronary intervention (PCI) for coronary bifurcation lesions; however, jailed balloon entrapment is a rare but serious complication. We report the case of a man in his 70s who was successfully resuscitated after out-of-hospital cardiac arrest due to ventricular fibrillation and underwent emergency PCI for a right coronary artery bifurcation lesion. A drug-eluting stent was deployed from the mid right coronary artery to the posterior descending branch using JBT. The jailed SB balloon became entrapped and could not be retrieved despite repeated inflation and deflation, traction, and rotational torque. Further traction resulted in deep engagement of the guiding catheter and an accordion phenomenon of the right coronary artery, raising concern about vascular injury. A balloon was therefore inflated within the stented main vessel, and forward pressure was applied to its shaft to provide counterforce against traction on the entrapped SB balloon. Using this technique, which we termed the "reverse balloon anchoring technique," the entrapped balloon was successfully retrieved without apparent device damage. Final angiography and intravascular ultrasound demonstrated preserved SB flow and adequate stent apposition. The reverse balloon anchoring technique may represent a useful bailout option for jailed balloon entrapment when conventional retrieval maneuvers fail.