Coronary balloon catheter tip damage. A bench study of a clinical problem

Abstract

ObjectivesTo confirm clinically that coronary balloon catheter tips may be damaged during bifurcation treatment with side‐branch access through the side of a stent. On the bench, we aimed to assess the susceptibility of different balloon designs to damage. We compared catheter tip widths. We tested whether balloon tip flaring can cause stent distortion.BackgroundWe had observed that balloon catheters that failed to cross to a side‐branch frequently exhibited tip damage.Methods and ResultsWe examined microscopically for damage 82 balloon tips after clinical side‐branch access. In a bench study, the forces required to compress catheter tips 0.5 mm were compared to assess susceptibility to damage. We compared tip widths of balloons of different nominal inflation diameters. We examined stents after side‐branch access for distortion. In 42 of 48 (88%) of balloon tips from patients with resistance to or failure to cross through the side of a stent there was tip damage. Even when the balloon crossed without perceptible resistance, tip damage occurred in over half of balloons 18/34 (53%). Some balloon designs were more resistant to damage than others. Tips from balloons of different nominal diameters from the same manufacturer had the same width. Stent distortion caused by damaged balloon tips is improved by kissing balloon post‐dilatation.ConclusionsBalloon tip damage is common with crossing between stent struts. This is one cause of failure of a balloon to access a side‐branch and a new balloon should be used. If stent distortion is suspected, it should be corrected with kissing balloon post‐dilatation.

Design of percutaneous transluminal coronary angioplasty balloon catheters

“…Fig. 2 ) and Barkholt et al [ 16 ]. A damaged tip may increase the crossing difficulty or cause stent distortion.…”

“…The tip design of the NC Trek, NC Emerge, and Accuforce was studied by Barkholt et al [ 16 ]. It was found that the NC Trek’s design was resistant to damage.…”

“…Even though balloon catheters have existed for several decades, not much literature about their design is publicly available [ 4 , 9 , 14 , 15 ]. Furthermore, in the past, Barkholt et al [ 16 ] investigated the tip design of PTCA balloon catheters. Gupta [ 17 ] explained PTCA balloon 'catheters' general design and properties [ 18 ].…”

Mechanical properties of the drug‐eluting bioresorbable magnesium scaffold compared with polymeric scaffolds and a permanent metallic drug‐eluting stent

“…If the rewired cell is only partly across the SB ostium, it is possible that struts are trapped and unable to move with the balloon expansion resulting in fracture. 25 The DESolve BRS and the ML8/Xience Xpedition did not fracture during SB dilatation or mini-KBPD.…”

“…The outliers where Magmaris fractured at low balloon pressures (Figure 5) may be related to the position of the rewired cell across the SB ostium. If the rewired cell is only partly across the SB ostium, it is possible that struts are trapped and unable to move with the balloon expansion resulting in fracture 25 . The DESolve BRS and the ML8/Xience Xpedition did not fracture during SB dilatation or mini‐KBPD.…”