Nightmare in the cath lab 😱 The balloon gets stuck after post-dilation. It gets worse the shaft breaks when you try to pull the system out - you can't retrieve it, you can't snare it. 😨What would you do? @jeroen_sonck jcspratt PCRonline 🫀

definitely HR racing scenario, lessons I learned from past: when balloon stuck, pull but not too hard; inflate back and deflate if possible; cut the shaft externally and advance guide extension all the way and then pull, likely to come out; usually there is a reasonable length of shaft where it breaks, if broken, try to trap the shaft with long big balloons and then pull; all else, surgeons are our friends

@jeroen_sonck @jcspratt @PCRonline Lots of shaft there! Still should be on the wire while in the lab? Goose neck should be able to snare? Fellow tip: when using the PRH technique watch on fluoro. If your right hand is pulling shaft but the balloon is not moving, the shaft is stretching. Continuing will fracture

@jeroen_sonck @jcspratt One of the reasons always good to have surgeons on-site

@jeroen_sonck @jcspratt @PCRonline That’s an effective although dramatic solution. You can submit this case to We can discuss what happened, possible alternative solutions, and all learn from it. Come join us in Seattle this summer!

@jeroen_sonck @jcspratt @PCRonline Had a case before. I managed by cutting the shaft of the balloon and advancing a guidezilla through it and constant pulling to retireve it as a whole.

@PCRonline @jeroen_sonck @jcspratt #ŌNŌ_helps

@jeroen_sonck @jcspratt @PCRonline We had a similar case of undeflated balloon with shaft rupture while pulling that was presented at 2 days ago. We could to retrieve the balloon with a trapping balloon inflated into the guiding catheter and pulling everything .

@jeroen_sonck @jcspratt @PCRonline Had same situation. We have opened the chest and used a small surgical needle to puncture the balloon. Then opened aorta and pulled the remaining shaft. Nightmare. Pt 86F. At 3y follow-up no MACE. .

@jeroen_sonck @jcspratt @PCRonline Guide extension & pull. Coronary snare. Subintimal track & distal rentry w stenting crushing the balloon. Or if anything works, surgery

@jeroen_sonck @jcspratt @PCRonline How to resolve this issue is dependent on mechanism. Did the balloon not deflate? Did the balloon become trapped in stent or in calcium? The PRH technique is last ditch as shaft fracture will occur. (PRH = Pull Real Hard)