Coronary artery rupture during balloon angioplasty, rescued with localized thrombin injection and coil embolization

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Percutaneous coronary intervention (PCI) carries a risk of coronary artery perforation.
• Guidewire-related perforations are typically small and managed with distal thrombin injection.
• Larger perforations, such as those induced by balloons, pose a significant management challenge.

Observation:

• A case of balloon-induced coronary artery rupture with a significant intrapericardial leak is presented.
• The rupture was a large, complex perforation, exceeding the typical indications for distal thrombin injection.
• Standard management options were considered insufficient or too invasive.

Findings:

• High-dose distal thrombin injection was administered for the coronary artery rupture.
• The intervention successfully sealed the rupture and resolved the intrapericardial leak.
• Non-surgical management was achieved, avoiding the need for further invasive procedures.

Implications:

• Distal thrombin injection can be a viable non-surgical treatment for significant coronary artery ruptures.
• This approach expands the therapeutic utility of thrombin for managing PCI-related complications.
• Further investigation into high-dose thrombin injection for complex coronary perforations is warranted.