{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:08:37Z","timestamp":1790291317202,"version":"4.1.0"},"reference-count":34,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background:Undeflatable coronary balloons during percutaneous coronary intervention (PCI) are rare but particularly hazardous because persistent intracoronary inflation can cause abrupt coronary occlusion, ischaemia, and haemodynamic collapse. We aimed to synthesise the published experience to define mechanistic patterns, identify recurring predisposing factors, and propose a practical bailout algorithm.Methods and Results:We performed a case-based review of PubMed, the Cochrane Library, and EBSCO from inception to February 2026. Eligible reports described balloons that could not be deflated while positioned in a coronary artery. A total of 15 coronary cases (2011\u20132025) met the inclusion criteria. Events occurred most often during post-dilatation or after stent deployment in complex anatomy, frequently involving severe calcification, aorto-ostial segments, chronic total occlusion-like lesions, and settings with limited guide engagement. Mechanistic patterns clustered into (i) intact-system non-deflation, where restoration of an exit pathway (system checks, sustained negative suction, and contrast dilution), followed by controlled decompression (wire puncture or mechanical- or energy-assisted disruption), was feasible; (ii) shaft-compromised events (fracture or detachment), where management shifted from decompression to mechanical retrieval, with surgery reserved for percutaneous failure.Conclusion:Undeflatable coronary balloons represent distinct failure modes with different viable rescue options. Outcomes appear to be driven by rapid restoration of perfusion and early recognition of shaft integrity. A structured escalation approach prioritising stabilisation, low-risk troubleshooting, controlled decompression, and decisive transition to retrieval, exclusion, or surgery when decompression is impossible could reduce secondary iatrogenic harm.<\/jats:p>","DOI":"10.31083\/rcm51754","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":1,"title":["Management of Undeflatable Coronary Balloons During Percutaneous Coronary Intervention: A Case-Based Review and Practical Bailout Algorithm"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7317-4237","authenticated-orcid":true,"given":"Allam","family":"Harfoush","sequence":"first","affiliation":[{"name":"Cardiology Department, North Bristol NHS Trust, BS10 5NB Bristol, UK"},{"name":"The Faculty of Medicine and Life Sciences, University of Chester, CH1 4BJ Chester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8734-011X","authenticated-orcid":true,"given":"Tammam","family":"Harfouch","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery, Radiology, and Cardiac Imaging Department, Saint Spiridon County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9638-3015","authenticated-orcid":true,"given":"Muntasir","family":"Abo-Al-Hayja","sequence":"additional","affiliation":[{"name":"Cardiology Department, Royal Liverpool University Hospital, L7 8YE Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1611-4702","authenticated-orcid":true,"given":"Khaled","family":"Albouaini","sequence":"additional","affiliation":[{"name":"Cardiology Department, Royal Liverpool University Hospital, L7 8YE Liverpool, UK"},{"name":"Cardiology Department, Liverpool Heart and Chest NHS Foundation Trust, L14 3PE Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Ezeldin","sequence":"additional","affiliation":[{"name":"General Medicinem, Queen Elizabeth Hospital, NE9 6SX Newcastle Upon Tyne, Gateshead, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6314-0236","authenticated-orcid":true,"given":"Hanady","family":"Hamdallah","sequence":"additional","affiliation":[{"name":"Department of Primary Care & Population Health, University College London, WC1E 6BT London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2688-6295","authenticated-orcid":true,"given":"Abdalazeem","family":"Ibrahem","sequence":"additional","affiliation":[{"name":"Cardiology Department, North Bristol NHS Trust, BS10 5NB Bristol, UK"},{"name":"School of Life and Medical Sciences, University of Hertfordshire, AL10 9EU Hertfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Li W, Wu Z, Peng H, Zhao D, Zheng Z, Tian B, et al. Predicting the Success Rate of Elective Percutaneous Coronary Intervention for Prior Failed Chronic Total Occlusion: a Novel Scoring System. Journal of Cardiovascular Translational Research. 2022; 15: 797\u2013804.","DOI":"10.1007\/s12265-021-10193-x"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Barash P, Akhtar S. Coronary stents: factors contributing to perioperative major adverse cardiovascular events. British Journal of Anaesthesia. 2010; 105 Suppl 1: i3\u201315.","DOI":"10.1093\/bja\/aeq318"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Haidar HA, Perier M, Benamer H. How to manage an entrapped undeflatable coronary balloon. Annales de Cardiologie et d\u2019Ang\u00e9iologie. 2024; 73: 101779.","DOI":"10.1016\/j.ancard.2024.101779"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Curran J, Burkhoff D, Kloner RA. Beyond Reperfusion: Acute Ventricular Unloading and Cardioprotection During Myocardial Infarction. Journal of Cardiovascular Translational Research. 2019; 12: 95\u2013106.","DOI":"10.1007\/s12265-019-9863-z"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Verevkin A, von Aspern K, Leontyev S, Lehmann S, Borger MA, Davierwala PM. Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention. Journal of the American Heart Association. 2019; 8: e010940.","DOI":"10.1161\/JAHA.118.010940"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Trivedi R. Double jeopardy: Failure to deflate stent balloon in rescue angioplasty. Interventional Medicine & Applied Science. 2019; 11: 128\u2013130.","DOI":"10.1556\/1646.11.2019.16"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Bostan M, Satiro\u011flu O, Erdo\u011fan T, Durako\u011flugil ME, U\u011furlu Y. A rare complication: Undeflatable balloon of the stent. Interventional Medicine & Applied Science. 2013; 5: 43\u201345.","DOI":"10.1556\/IMAS.5.2013.1.9"},{"key":"ref8","unstructured":"Girish MP, Gupta MD, Mittal A. Percutaneous retrieval of entrapped partially inflated broken coronary angioplasty balloon by modified Fogarty technique. The Journal of Invasive Cardiology. 2011; 23: E173\u2013E176."},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Han F, Ma D, Wan Q, Huang Y, Huang Z, Wang F, et al. Bailout Retrieval of an Entrapped, Fractured, and Undeflatable Stent Balloon in the Left Main Coronary Artery: A Salvage Procedure During Cardiac Arrest. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2026; 107: 1120\u20131126.","DOI":"10.1002\/ccd.70453"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Omer AR, Bianco M, Lodhi A, Sattur S, Kaluski E. Angioplasty Balloon Entrapped Fully Inflated and Detached Within the Left Main Coronary Artery. Cardiovascular Revascularization Medicine : Including Molecular Interventions. 2020; 21: 21\u201324.","DOI":"10.1016\/j.carrev.2020.02.006"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Girish MP, Gupta MD, Tyagi S. Entrapped coronary angioplasty stent balloon due to nondeflation: percutaneous retrieval by a simple technique. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2011; 77: 58\u201361.","DOI":"10.1002\/ccd.22617"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Takama T, Ito Y, Ishimori H, Tsukahara R, Muramatsu T. Failure of a balloon to deflate during post dilatation in a coronary artery. Cardiovascular Intervention and Therapeutics. 2015; 30: 57\u201360.","DOI":"10.1007\/s12928-014-0249-5"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Kim SH, Lee SH, Kim J, Chun KJ. Multiple coronary artery perforation as a fatal complication during the management of an undeflatable stent balloon: a case report. Frontiers in Cardiovascular Medicine. 2025; 12: 1565014.","DOI":"10.3389\/fcvm.2025.1565014"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Yumul AR, Yahaya SA, Ganesan KG, Kolanthaivelu J, Aris FA, Mohamed Nazeeb MN, et al. TCTAP C-102 management and retrieval of undeflatable non-compliant coronary balloon during percutaneous coronary intervention. JACC. 2022; 79: S252\u2013S253.","DOI":"10.1016\/j.jacc.2022.03.231"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Savvoulidis P, Bagur R, Ybarra LF. Retrieval of Undeflatable Stent Balloon Using Laser Energy. Cardiovascular Revascularization Medicine : Including Molecular Interventions. 2021; 28S: 136\u2013139.","DOI":"10.1016\/j.carrev.2020.10.024"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Chitturi KR, Verma BR, Hill AP, Haberman D, Lupu L, Case BC, et al. Percutaneous Bailout of an Entrapped Coronary Intravascular Lithotripsy Balloon. JACC. Cardiovascular Interventions. 2025; 18: 265\u2013267.","DOI":"10.1016\/j.jcin.2024.10.015"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Gibson S, Lim C. The undeflatable angioplasty balloon: A feared complication of percutaneous coronary intervention. Heart, Lung and Circulation. 2025; 34: S459\u2013S460.","DOI":"10.1016\/j.hlc.2025.06.579"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Yang Y, Yang S, Cheng X, Liu K. A rare case report of the successful withdrawal of a stent balloon that failed to deflate. BMC Cardiovascular Disorders. 2023; 23: 190.","DOI":"10.1186\/s12872-023-03215-w"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Leibundgut G, Degen C, Riede F. Transcutaneous Puncture of an Undeflatable Coronary Angioplasty Balloon Catheter. Case Reports in Cardiology. 2018; 2018: 6252809.","DOI":"10.1155\/2018\/6252809"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Okabe K, Hagiya K, Takamisawa I, Iwakura T, Nanasato M. Retrieval of an Undeflatable Balloon During Percutaneous Coronary Intervention in Combination With Small Thoracotomy. JACC. Case Reports. 2025; 30: 105157.","DOI":"10.1016\/j.jaccas.2025.105157"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Mogabgab O, Patel VG, Michael TT, Kotsia A, Christopoulos G, Banerjee S, et al. Impact of contrast agent viscosity on coronary balloon deflation times: bench testing results. Journal of Interventional Cardiology. 2014; 27: 177\u2013181.","DOI":"10.1111\/joic.12097"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Sanz-S\u00e1nchez J, Mashayekhi K, Agostoni P, Egred M, Avran A, Kalyanasundaram A, et al. Device entrapment during percutaneous coronary intervention. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2022; 99: 1766\u20131777.","DOI":"10.1002\/ccd.30160"},{"key":"ref23","unstructured":"ISO. Intravascular catheters\u2014Sterile and single-use catheters. 2023. Available at: https:\/\/www.iso.org\/standard\/76495.html (Accessed: 15 February 2026)."},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Nanjappa V, Sreedhara R, Sadanand KS, Ravindranath KS. Case report: pierced-balloon technique for navigating difficult side branch angulation in a critical left main coronary artery bifurcation disease. European Heart Journal. Case Reports. 2025; 9: ytaf434.","DOI":"10.1093\/ehjcr\/ytaf434"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Holmes DR Jr, Reeder GS, Ghazzal ZM, Bresnahan JF, King SB 3rd, Leon MB, et al. Coronary perforation after excimer laser coronary angioplasty: the Excimer Laser Coronary Angioplasty Registry experience. Journal of the American College of Cardiology. 1994; 23: 330\u2013335.","DOI":"10.1016\/0735-1097(94)90415-4"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Mohandes M, Pernigotti A, Torres M, Ambroj CM, Fern\u00e1ndez F, Bejarano-Arosemena R, et al. Excimer Laser Coronary Atherectomy: Current Evidence, Clinical Applications, and Future Directions. Journal of Clinical Medicine. 2026; 15: 766.","DOI":"10.3390\/jcm15020766"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Gasparini GL, Sanz-Sanchez J, Regazzoli D, Boccuzzi G, Oreglia JA, Gagnor A, et al. Device entrapment during percutaneous coronary intervention of chronic total occlusions: incidence and management strategies. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2021; 17: 212\u2013219.","DOI":"10.4244\/EIJ-D-20-00781"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Shah P, Bajaj S, Shamoon F. Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases. Texas Heart Institute Journal. 2016; 43: 52\u201360.","DOI":"10.14503\/THIJ-14-4585"},{"key":"ref29","unstructured":"Nair P, Roguin A. Coronary perforations. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2006; 2: 363\u2013370."},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Mikhail P, Howden N, Monjur M, Jeyaprakash P, Said C, Bland A, et al. Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis. Open Heart. 2022; 9: e002076.","DOI":"10.1136\/openhrt-2022-002076"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Mizrahi I, Bose S, Leibowitz A. Management of Intra-Aortic Balloon Rupture and Entrapment. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33: 1983\u20131987.","DOI":"10.1053\/j.jvca.2018.08.023"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Grines CL, Box LC, Mamas MA, Abbott JD, Blankenship JC, Carr JG, et al. SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Journal of the Society for Cardiovascular Angiography & Interventions. 2023; 2: 100560.","DOI":"10.1016\/j.jscai.2022.100560"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Valvo R, Costa G, Tamburino C, Barbanti M. Coronary artery cannulation after transcatheter aortic valve implantation. EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2021; 17: 835\u2013847.","DOI":"10.4244\/EIJ-D-21-00158"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Neuser J, Kempf T, Bauersachs J, Widder JD. Novel self-expanding ALLEGRA transcatheter aortic valve for native aortic stenosis and degenerated bioprosthesis. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2022; 99: 1234\u20131242.","DOI":"10.1002\/ccd.30003"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM51754","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:32:15Z","timestamp":1785407535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM51754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02399-9"],"URL":"https:\/\/doi.org\/10.31083\/rcm51754","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"article-number":"51754"}}