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Case Reports
Published online: 2019-07-02
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Embolization of covered stent during bailout of a coronary perforation — a double jeopardy

Santosh Kumar Sinha, Vinay Krishna, Mahmodula Razi, Siddarth Samrat
DOI: 10.5603/FC.a2019.0085

open access

Ahead of print
Case Reports
Published online: 2019-07-02

Abstract

Coronary perforation is rare, but dreaded complication of percutaneous coronary intervention (PCI), which may be type-I (extra luminal crater), II (myocardial or pericardial staining), and III (contrast streaming). Type-III perforations, most dreaded one, are managed with reversal of anticoagulation and prolonged balloon tamponade, covered stents, and rarely emergent surgical repair. Here, we report case of 74-year-old diabetic and hypertensive female who had suffered type-III perforation during PCI by predilatation with semicompliant balloon of mid left anterior descending artery (LAD) lesion as it was calcified. During deployment of covered stent, it got embolized into guiding catheter as we tried to forcefully push the stent, but could not do so as the bed was not fully prepared. It was successfully retrieved with semicompliant monorail balloon, and deployed to seal the perforation. LAD was finally stented with another drug eluting stent distally overlapping with covered stent proximally achieving optimal result.

Abstract

Coronary perforation is rare, but dreaded complication of percutaneous coronary intervention (PCI), which may be type-I (extra luminal crater), II (myocardial or pericardial staining), and III (contrast streaming). Type-III perforations, most dreaded one, are managed with reversal of anticoagulation and prolonged balloon tamponade, covered stents, and rarely emergent surgical repair. Here, we report case of 74-year-old diabetic and hypertensive female who had suffered type-III perforation during PCI by predilatation with semicompliant balloon of mid left anterior descending artery (LAD) lesion as it was calcified. During deployment of covered stent, it got embolized into guiding catheter as we tried to forcefully push the stent, but could not do so as the bed was not fully prepared. It was successfully retrieved with semicompliant monorail balloon, and deployed to seal the perforation. LAD was finally stented with another drug eluting stent distally overlapping with covered stent proximally achieving optimal result.

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Keywords

Coronary perforation; Percutaneous coronary intervention; Covered stent; Stent embolization.

About this article
Title

Embolization of covered stent during bailout of a coronary perforation — a double jeopardy

Journal

Folia Cardiologica

Issue

Ahead of print

Published online

2019-07-02

DOI

10.5603/FC.a2019.0085

Keywords

Coronary perforation
Percutaneous coronary intervention
Covered stent
Stent embolization.

Authors

Santosh Kumar Sinha
Vinay Krishna
Mahmodula Razi
Siddarth Samrat

References (12)
  1. Al-Mukhaini M, Panduranga P, Sulaiman K, et al. Coronary perforation and covered stents: an update and review. Heart Views. 2011; 12(2): 63–70.
  2. Shirakabe A, Takano H, Nakamura S, et al. Coronary perforation during percutaneous coronary intervention. Int Heart J. 2007; 48(1): 1–9.
  3. Kiernan TJ, Yan BP, Ruggiero N, et al. Coronary artery perforations in the contemporary interventional era. J Interv Cardiol. 2009; 22(4): 350–353.
  4. Shimony A, Zahger D, Van Straten M, et al. Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2009; 104(12): 1674–1677.
  5. Ellis SG, Ajluni S, Arnold AZ, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994; 90(6): 2725–2730.
  6. Karabulut A, Topçu K. Coronary perforation due to sirolimus-eluting stent's strut rupture with post-dilatation. Kardiol Pol. 2011; 69(2): 183–6; discussion 187.
  7. Lee WC, Hsueh SK, Fang CY, et al. Clinical Outcomes Following Covered Stent for the Treatment of Coronary Artery Perforation. J Interv Cardiol. 2016; 29(6): 569–575.
  8. Jamshidi P, Mahmoody K, Erne P. Covered stents: a review. Int J Cardiol. 2008; 130(3): 310–318.
  9. Lansky AJ, Yang Ym, Khan Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006; 98(3): 370–374.
  10. Nasrin S, Cader FA, Haq MM, et al. Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report. BMC Res Notes. 2017; 10(1): 537.
  11. Brilakis ES, Best PJM, Elesber AA, et al. Incidence, retrieval methods, and outcomes of stent loss during percutaneous coronary intervention: a large single-center experience. Catheter Cardiovasc Interv. 2005; 66(3): 333–340.
  12. Stent Complications. J Invasive Cardiol. 1998; 10(7): 385–395.

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