Balloon Uncrossable Left Main Coronary Artery Dissection: A Case Report and Literature Review

Coronary artery dissection presents a high-risk scenario, particularly when complicated by severe calcification. We report a complex case of a balloon-uncrossable lesion encountered during percutaneous coronary intervention (PCI) of a calcified ostial-to-mid left anterior descending (LAD) artery lesion extending into the LMCA. A 54-year-old male with type 2 diabetes and exertional angina underwent coronary angiography revealing severe calcified LAD disease. Despite successful initial balloon pre-dilatation, a drug-eluting stent (DES) could not cross the lesion. Withdrawal attempts resulted in a large LMCA-to-LAD dissection flap, preventing further device passage. Urgent multidisciplinary consultation was initiated. A novel approach using forceful advancement of a 1.0 mm semi-compliant balloon during deflation enabled successful lesion crossing. This was followed by lesion preparation, overlapping DES deployment, and optimized post-dilatation. The patient remained stable, with excellent angiographic results. This case underscores the importance of innovation and teamwork in managing complex, calcified coronary lesions with unexpected procedural complications.