EuroPCR2026-images-105717-Unexpected-complication-left-main-bifurcation-PCI

The likely mechanism was the use of an oversized balloon in the left main segment in the presence of significant aorto-ostial calcification. Calcified and rigid vessel walls can reduce vessel compliance and increase susceptibility to injury when exposed to high radial forces from oversized balloons.However, patients’ blood pressure was stable, and no pericardial fluid was found. The complication was successfully managed by deploying an additional DES.This case highlights the importance of accurate vessel sizing, preferably guided by intravascular imaging such as IVUS or OCT, especially in calcified left main lesions. Operators should avoid oversizing balloons and apply controlled inflation pressures during the crush step. Careful attention to balloon diameter and lesion characteristics is essential to minimize the risk of catastrophic complications such as coronary perforation during left main bifurcation PCI.

 

The likely mechanism was the use of an oversized balloon in the left main segment in the presence of significant aorto-ostial calcification. Calcified and rigid vessel walls can reduce vessel compliance and increase susceptibility to injury when exposed to high radial forces from oversized balloons.However, patients’ blood pressure was stable, and no pericardial fluid was found. The complication was successfully managed by deploying an additional DES.This case highlights the importance of accurate vessel sizing, preferably guided by intravascular imaging such as IVUS or OCT, especially in calcified left main lesions. Operators should avoid oversizing balloons and apply controlled inflation pressures during the crush step. Careful attention to balloon diameter and lesion characteristics is essential to minimize the risk of catastrophic complications such as coronary perforation during left main bifurcation PCI.