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

Background 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. Case summary 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. Discussion 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.