Akademik Veri Yönetim Sistemi
Kardiyovasküler Akademi Kongresi, Girne, Kıbrıs (Kktc), 18 - 22 Eylül 2024, cilt.1, sa.1, ss.108-109, (Özet Bildiri)
Coronary artery perforation (CAP) is a rare complication during percutaneous coronary intervention with a mortality rate of 0.2-0.5%. CAP, one of the most feared complications, can cause pericardial effusion and tamponade, cardiogenic shock and mortality. The accumulation of effusion in coronary artery perforations often develops rapidly, often causes hypotension and can be followed by pericardiocentesis, and in rare cases, cardiac surgery may be required. We wanted to share a case of Ellis stage 3 CAP in a patient undergoing percutaneous coronary intervention for STEMI.
A 53-year-old male patient was admitted to the emergency department with compressive chest pain. Electrocardiography revealed ST segment elevation in anterior leads and reciprocal ST segment depressions and he was taken to the catheter laboratory with a diagnosis of anterior MI. In our patient, perforation occurred after the LAD total occluded lesion was crossed with a floppy guide-wire and balloon dilatation was performed. It was observed that the perforation had regressed in the control imaging after prolonged balloon inflation in the proximal area and waiting for cardiovascular surgery consultation.
After ballooning over the pilot 50 wire, which was delivered to the LAD as a second wire, it was seen that flow was achieved. Subsequently, stent implantation was performed in the LAD. Upon observation of thrombus in the LAD diagonal, rewiring was performed and TIMI 3 flow was achieved with the balloon. After 3 months of follow-up, the patient had angina and control angiography was performed. LAD TIMI 3 flow was observed and the stent was patent. Medical treatment was organized and the patient did not have any complaints during follow-up.
One of the most important complications of the PCI procedure is CAP. Surgery or graft stents are treatment options. However, while waiting for these interventions, prolonged balloon dilatation proximal to the perforation may be an option.