‘Balloon screen’ technique: a case report of a novel bailout strategy for accurate stent deployment in severely calcified coronary lesions complicated by dissection

Severely calcified coronary lesions may require atherectomy and imaging guidance, yet procedural dissection can create a false lumen that repeatedly captures devices, risking inadvertent false-lumen stenting.

A 77-year-old man with Canadian Cardiovascular Society class III angina had severe diffuse calcification in the left anterior descending artery (ACC/AHA type B2; SYNTAX I 22; SYNTAX II 48.7). Although anatomical complexity was moderate, the SYNTAX II score was driven by advanced age and lower extremity artery disease. After rotational atherectomy (1.5-mm burr) and high-pressure scoring balloon angioplasty, guidewire exchange was complicated by migration into a false lumen behind circumferential calcium. Although a second wire was advanced into the true lumen using a double-lumen catheter, repeated attempts to deliver a drug-eluting stent deviated into the false channel. A semi-compliant balloon was therefore advanced into the false lumen and gently inflated to temporarily block it (‘balloon screen’), enabling stent delivery over the true-lumen wire. An Onyx Frontier 3.0 × 38 mm stent was deployed, and intravascular ultrasound confirmed excellent expansion. The patient was discharged the next day and remained asymptomatic at 6-month follow-up; key steps are shown in Supplementary material online, Videos S1–S3.

The balloon screen technique provides a practical bailout when stent delivery repeatedly tracks a false lumen after dissection in heavily calcified lesions. Creating a temporary physical barrier within the false channel, it promotes accurate true-lumen stenting, but careful balloon handling is required.