Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report

SummaryA 73-year-old male with diabetes mellitus was referred for coronary angiography (CAG). He presented with stable effort angina pectoris. CAG showed a significant stenotic lesion in the proximal-segment of the left anterior descending (LAD) coronary artery with heavy calcification. He then underwent angioplasty for the LAD stenosis. On the second balloon dilatation, the balloon was inflated to 22 atm, at which point the balloon waist had not yet yielded and balloon rupture occurred. Immediately after the procedure, CAG showed no-reflow phenomena and chest pain occurred. Intravascular ultrasound (IVUS) imaging revealed a dissection into the media with extension into the medial space without reentry, and demonstrated significant stenosis and obstruction of the distal LAD with a semilunar echo-dense intramural hematoma. To bail out, two bare metal stents were deployed. After the procedure, proper stents expansion and no residual dissection flap were detected either by IVUS or CAG. The final CAG showed a good result with TIMI-3 coronary flow. This case highlights balloon rupture during coronary angioplasty with heavy calcification caused no-reflow phenomena by dissection and intramural hematoma of the coronary artery. We could bail out hematoma by coronary stent implantation with complete cover of the coronary dissection.