case_images: PMC6140099_01
case_images: Angiography. (a) Implantation of XIENCE Xpedition 3.5/48 DES. (b) Undeflatable balloon stuck to the RCA ostium. (c) Undeflated balloon in the radial artery. (d) Transcutaneous puncture with a 23 gauge needle. (e) Aspiration of contrast media with complete deflation of the balloon. (f) Injection of contrast media through the radial sheath confirms patent radial artery.
case_images: CRIC2018-6252809.001.jpg
case_images: PMC6140099_01_CRIC2018-6252809.001.jpg
case_images: fig1
case_images: A 3.5/48 drug-eluting stent (DES) (XIENCE Xpedition, Abbot Vascular) was then placed in the predilated coronary segment and inflated to 18 atm (Figure 1(a)). A mixture of contrast media and saline at a ratio of 1 : 1 was used for all balloon inflations. After a second more proximal inflation, the balloon catheter did not deflate completely and the operator was unable to pull it back into the 5F guiding catheter (Figure 1(b)). Moreover, a forced pullback of the partially inflated balloon catheter resulted in invagination of the distal part of the balloon (Figure 1(c), white arrow). After injecting local anesthesia on the middle forearm, transcutaneous puncture of the balloon through the skin and the radial artery wall was performed with a 23 gauge syringe needle using fluoroscopy for guidance (Figure 1(d)), and contrast media were aspirated with the syringe (Figure 1(e)). Injection of contrast media through the sheath confirmed the integrity of the radial artery at the puncture site (Figure 1(f)).