Unusual balloon rupture during direct stenting with a TaxusExpress stent in a venous graft complicated by vessel rupture: a device-related fatal event

A 70-year-old male with a prior coronary artery bypass operation presented with increasing episodes of chest pain. Coronary angiography revealed severe disease of the left anterior descending artery (LAD), CX, and RCA. A left internal mammary artery to LAD was patent. A jump venous graft, with four distal anastomoses, had two significant stenoses. Percutaneous coronary intervention with distal protection, and direct stenting with a drug-eluting stent, was planned. A 3.00 x 16 mm TaxusExpress (Boston Scientific) was used. At an inflation pressure of 10 atm the stent balloon seemed to extend 20 mm proximally with a diameter of 4.5 mm, and the balloon ruptured. Angiography showed rupture of the vessel proximal to the implanted stent, and the patient developed severe hypotension. The rupture was treated with a covered stent and pericardiocentesis was performed with evacuation of 600 mL blood. However, it was not possible to resuscitate the patient, who died due to severe pump failure and incessant ventricular fibrillation.