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Updated: Jul 15, 2026
A Hydrogel Construct and Fibrin-based Glue Approach to Deliver Therapeutics in a Murine Myocardial Infarction Model.
Published on: June 14, 2015
Closure of guide wire-induced coronary artery perforation with a two-component fibrin glue
1Red Cross Hospital Cardiology Center, Frankfurt, Germany.
Insights
A novel technique using fibrin glue successfully closed a coronary artery rupture after percutaneous coronary intervention (PCI). This rapid, two-component injection method offers a new emergency treatment for this life-threatening PCI complication.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) can lead to life-threatening coronary artery perforation, pericardial effusion, and cardiac tamponade.
- Existing emergency treatments include anticoagulation reversal, balloon inflation, stent grafts, thrombogenic agents, microcoils, or surgery.
Observation:
- A 66-year-old patient developed cardiac tamponade post-PCI for acute stent thrombosis.
- Guide wire-induced perforation of a distal diagonal branch was identified, with leakage persisting after prolonged balloon inflation.
Findings:
- A novel technique involved rapid, separate injection of a two-component fibrin glue (fibrinogen and thrombin) via an over-the-wire balloon.
- This successfully sealed the coronary rupture without reversing anticoagulation, representing a distinct approach from prior thrombin injection methods.
Implications:
- This fibrin glue technique provides a rapid and effective rescue strategy for coronary artery rupture during PCI.
- It offers a valuable alternative in catheterization labs utilizing monorail systems, potentially improving patient outcomes in emergent situations.
Abstract:
Perforation or rupture of a coronary artery with subsequent pericardial effusion and cardiac tamponade is a potentially life-threatening complication of percutaneous coronary intervention (PCI). Several emergency treatment strategies exist to close the perforation including reversal of anticoagulation, prolonged balloon inflation, implantation of stent grafts, local injection of thrombogenic molecules, placement of microcoils, or open heart surgery. Here we report on a 66-year-old patient who underwent urgent PCI for acute stent thrombosis in the proximal LAD. The artery was reopened, a new stent implanted successfully, and a GPIIb/IIIa-antagonist was given. Shortly thereafter the patient suffered from cardiac tamponade requiring pericardiocentesis and pericardial drainage. The coronary angiogram indicated a severe guide wire-induced perforation and pericardial effusion originating from a distal diagonal branch segment. Prolonged balloon inflation did not stop the leakage. Therefore the monorail balloon was exchanged for an over-the-wire balloon. A two-component commercial fibrin glue consisting of fibrinogen and thrombin was rapidly but separately injected through the wire channel of the balloon into the distal segment of the diagonal branch. The coronary leak was successfully closed and the patient recovered quickly. In comparison with the previously reported cases of thrombin injection important differences should be noticed: (1) a two-component hemostatic seal was used without reversal of anticoagulation, (2) rapid injection instead of prolonged infusion of the hemostatic drugs was performed, and (3) the rescue technique was applied in a cath lab that routinely uses monorail catheter systems. Therefore we consider this a novel and effective approach for closure of coronary ruptures.
