Use of Trapping Techniques and a GooseNeck Snare to Retrieve a Fractured Balloon Catheter

Keywords: balloon catheter, percutaneous coronary intervention, trapping technique

A 47-year-old male lifelong smoker underwent percutaneous coronary intervention (PCI) to the distal segment of an ectatic right coronary artery (RCA) in the context of non–ST-elevation myocardial infarction (NSTEMI) (Figure 1A and Video 1). The procedure was intravascular ultrasound guided using an Amplatz Left 1 guide and Sion Blue wire (Asahi Intecc). After lesion preparation with semicompliant balloons, a Synergy 4 x 48-mm coronary stent (Boston Scientific) was delivered with support of a 6-Fr guide-catheter extension and optimized using 4.5 x 15-mm and 5.0 x 8-mm noncompliant balloons. Upon retrieval of the 5.0-mm balloon, the distal part detached from the shaft in the proximal RCA, leading to acute vessel closure, chest pain, and inferior ST-segment elevation (Figure 1B). With the detached balloon shaft partially lodged in the catheter tip, a 2 x 12-mm balloon was advanced in parallel and inflated at 18 atm to trap the detached shaft in the guide (Figure 1C and Video 1). The entire system was withdrawn, restoring antegrade flow. Upon retrieval, the device detached in the distal radial artery and had to be retrieved using a 15-mm GooseNeck snare (ev3) (Figures 1D-1F). A subsequent angiogram demonstrated a patent RCA and no evidence of dissection.

Percutaneous transluminal coronary angioplasty balloon fracture, retention, and embolization are rare complications of PCI. The incidence has historically been estimated at ≤0.8%, which is likely an underestimate given the increasing quantity and complexity of percutaneous procedures.^1,2 We demonstrate how to avoid emergency surgery by using basic balloon trapping techniques and a snare in the more distal arterial bed.

Affiliations and Disclosures

From the ¹Cardiology Department, St Thomas’ Hospital, London, United Kingdom; ²Cardiology Department, Mitera Hospital, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 17, 2022.

Address for correspondence: Antonis N. Pavlidis, MD, PhD, Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Email: antonis.pavlidis@gstt.nhs.uk

References

1. Iturbe JM, Abdel-Karim A-RR, Papayannis A, et al. Frequency, treatment, and consequences of device loss and entrapment in contemporary percutaneous coronary interventions. J Invasive Cardiol. 2012;24(5):215-221.

2. Waldo SW, Gokhale M, O’Donnell CI, et al. Temporal trends in coronary angiography and percutaneous coronary intervention: insights from the VA clinical assessment, reporting, and tracking program. JACC Cardiovasc Interv. 2018;11(9):879-888. doi:10.1016/j.jcin.2018.02.035