Left Main Coronary Artery Perforation Treated with Conventional Stent (A Real Management Dilemma)
Keywords:Left Main, Anterior Wall Myocardial Infarction, Percutaneous Coronary Intervention, Drug-Eluting Stent, In-Stent Restenosis, Covered Stent, A Case Report.
Background: Left main coronary artery (LMCA) perforation is a very rare complication of percutaneous coronary intervention (PCI); there is a scarcity of data for its treatment and almost a lack of literature for the use of regular coronary stent for its management.
Case Presentation: We report a case of 90 years old male who presented with anterior wall myocardial infarction (AWMI) and developed Ellis Type 3 coronary artery perforation in calcified LMCA. Post dilatation of ostial Left anterior descending artery (LAD) stent was successfully managed with the deployment of regular drug-eluting stent (DES), preceded by immediate balloon tamponade.
Management & Results: The patient remained hemodynamically stable, and his echocardiogram did not show pericardial effusion or tamponade and was discharged home eventually in a stable condition.
Conclusion: In conclusion, LMCA perforation may occur during high-pressure post dilatation of calcified artery as evident from earlier studies but can be managed successfully with conventional coronary artery stent placement, provided there will be no hemodynamic compromise or tamponade. This case report has introduced a new concept of managing coronary artery perforation, which may reduce the risk of in-stent restenosis significantly associated with using a covered stent.
Gunning MG, Williams IL, Jewitt DE, Shah AM, Wainwright RJ, Thomas MR. Coronary artery perforation during the percutaneous intervention: incidence and outcome. Heart. 2002; 88(5) :495-498.
Ellis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, Cowley MJ, Raymond RE, Safian RD, Whitlow PL. Increased coronary perforation in the new device era.
Incidence, classification, management, and outcome. Circulation. 1994; 90(6): 2725-2730.
Sapontis J, Salisbury AC, Yeh RW, Cohen DJ, Hirai T, Lombardi W, McCabe JM, Karmpaliotis D, Moses J, Nicholson WJ, Pershad A. Early procedural and health status outcomes after chronic total occlusion angioplasty: a report from the OPEN-CTO registry (outcomes, patient health status, and efficiency in chronic total occlusion hybrid procedures). JACC Cardiovasc Interv. 2017; 10(15): 1523–1534.
Giannini F, Candilio L, Mitomo S, Ruparelia N, Chieffo A, Baldetti L, Ponticelli F, Latib A, Colombo A. A practical approach to the management of complications during percutaneous coronary intervention. JACC Cardiovasc Interv. 2018; 11(18): 1797-1810.
How to Cite
Copyright (c) 2021 The Author
This work is licensed under a Creative Commons Attribution 4.0 International License.