AUTHOR=Kim Seok Hyun , Lee Sang Hyun , Kim Jeongsu , Chun Kook Jin 

TITLE=Multiple coronary artery perforation as a fatal complication during the management of an undeflatable stent balloon: a case report

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1565014

DOI=10.3389/fcvm.2025.1565014

ISSN=2297-055X

ABSTRACT=BackgroundAn undeflatable stent balloon following its inflation during percutaneous coronary intervention (PCI) is a rare and unpredictable complication that can lead to serious consequences. Currently, there is no standardized protocol for managing this issue.Case presentationAn 83-year-old man presented with chest pain. Coronary angiography showed a chronic total occlusion (CTO)-like lesion in the proximal left anterior descending coronary artery (LAD). Following stent deployment, the balloon failed to deflate and remained inflated within the LAD. Despite multiple retrieval attempts, the issue remained unresolved. As an alternative to surgical removal, we inflated the balloon beyond its rated burst pressure within the coronary artery. The balloon eventually ruptured and was successfully retrieved; However, this resulted in multiple severe coronary perforations, which were effectively sealed using covered stents.ConclusionBalloon deflation failure is an exceptionally rare, unpredictable, and critical complication of PCI. While various troubleshooting strategies exist, inflating an undeflatable balloon beyond its burst pressure should be considered only as a last resort, with thorough preparation for potential complications.