A 68-year-old lady with acute anterolateral myocardial infarction was referred to our center 3 h from symptom onset for emergent coronarography and percutaneous coronary intervention. Administration of abciximab was started immediately upon admission to the catheterization laboratory. The coronary angiography revealed a para-ostial occlusion of the left anterior descending (LAD) coronary artery ( Fig. 1 , Panel A) and normal left circumflex (LCx) and right coronary artery. Recanalization of the LAD was obtained after multiple dilation with a 2.0×20-mm and a 2.0×30-mm angioplasty balloon (Panel B): the residual stenosis and ostial LAD and first diagonal branch were treated with a Vision 2.5×18-mm bare metal stent (Abbot Vascular, Abbott Park, IL, USA) and kissing balloon inflation was performed after wiring the diagonal branch. A Sprinter NC 2.75×12-mm balloon catheter for the LAD and a Sprinter Legend 1.5×15-mm balloon catheter (Medtronic, Minneapolis, MN, USA) for the diagonal branch were simultaneously inflated at 14 atm, but suddenly after the start of the inflation, the 1.5-mm balloon ruptured with back air embolism in the LCx and in the LAD (Panel C) resulting in complete left coronary artery no-reflow, cardiac arrest, and ventricular fibrillation (Panel D). The patient was immediately treated with cardiac massage, intravenous adrenalin, and ventilation which were all unsuccessful. Because of mechanical dissociation and no-reflow, while the IABP was set to emergent use, the LCx was wired and manual aspiration with a 6F Export thrombectomy catheter (Medtronic) was performed in both the LAD and LCx (Panel E) with complete and immediate TIMI 3 blood flow restoration and increase of blood pressure to 115/80 mmHg (Panel F). The patient was transferred in the ICU and was discharged after 7 days without other complications.
