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Left internal mammary artery graft perforation due to high-pressure stent deployment
M Sharifi1, M W Turrentine, Y Mahomed
1Department of Medicine, The Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202, USA.
Insights
A rare complication of coronary interventions, left internal mammary artery (LIMA) graft perforation after stent deployment, can cause severe bleeding. Prompt treatment involving pericardiocentesis and surgery can be life-saving.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Graft Complications
Background:
- Coronary artery bypass grafting (CABG) frequently utilizes the left internal mammary artery (LIMA) for its durability.
- Stent deployment during percutaneous coronary intervention (PCI) is a standard procedure.
- Perforation of a newly placed LIMA graft during PCI is a rare but serious complication.
Observation:
- A patient developed a perforation of a LIMA graft 12 days after CABG surgery.
- The perforation occurred during stent deployment using a high-pressure balloon.
- This complication led to significant hemorrhage and cardiac tamponade.
Findings:
- The patient underwent emergent pericardiocentesis to relieve cardiac tamponade.
- Rapid autotransfusion of pericardial aspirate was performed.
- Surgical repair of the ruptured LIMA graft was successfully accomplished.
Implications:
- This case highlights the potential risks associated with PCI in patients with recent LIMA grafts.
- Timely and aggressive management, including pericardiocentesis and surgical repair, is crucial for favorable outcomes.
- Further research may explore preventative strategies to minimize LIMA graft injury during PCI.
Abstract:
Perforation of newly placed left internal mammary artery (LIMA) grafts due to stent deployment is an infrequent but potentially dangerous complication of coronary interventions. It may lead to brisk hemorrhage and massive cardiac tamponade requiring emergent pericardiocentesis and surgery. We report a case of a LIMA graft perforation following stent deployment with a high-pressure balloon 12 days after surgery. The patient was treated with emergent pericardiocentesis, rapid autotransfusion of the pericardial aspirate into the systemic circulation, and surgical repair of the ruptured vessel.