Transcatheter embolization by autologous blood clot is useful management for small side branch perforation due to percutaneous coronary intervention guide wire
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Updated: Jun 27, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Shinichiro Tanaka1, Kazuhiko Nishigaki, Shinsuke Ojio
1Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu City, Gifu 501-1194, Japan.
Insights
This study demonstrates a novel technique using autologous blood clots to successfully repair coronary artery perforations during percutaneous coronary intervention (PCI). This method effectively occludes the damaged vessel, preventing myocardial damage and ensuring good coronary flow post-procedure.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Coronary artery perforation is a rare but serious complication during PCI.
- Managing side branch perforations can be challenging, potentially leading to adverse outcomes.
Observation:
- A 75-year-old male patient experienced a coronary perforation in a small side branch of the left coronary artery during PCI for a bifurcation lesion.
- Initial attempts to repair the perforation with balloon inflation were unsuccessful.
- A novel technique involving the occlusion of the perforated side branch with an autologous blood clot was employed.
Findings:
- The autologous blood clot, delivered via a microcatheter and suspended in contrast media and saline, successfully occluded the small branch and repaired the perforation.
- No significant creatine phosphokinase (CPK) elevation was detected post-procedure.
- Follow-up at 6 months showed improved embolization and good coronary flow, indicating successful repair without myocardial damage.
Implications:
- Autologous blood clots offer a viable and effective method for managing coronary artery perforations in small side branches.
- This technique may reduce the risk of myocardial damage and improve procedural success rates in complex PCI cases.
- Further research into this approach could establish it as a standard treatment for specific PCI-related complications.
Abstract:
A 75-year-old man underwent PCI for a bifurcation lesion with 90% stenosis in segment 6 and 75% proximal stenosis in segment 9 of the left coronary artery. We implanted a Duraflex coronary stent into segment 6 and kissing balloon inflation for segments 6 and 9. Although these 2 lesions were adequately dilated, we noticed coronary perforation caused by the guide wire in a small branch of segment 9. We tried to repair the perforation using a small balloon and long inflation, but unfortunately the perforation was not improved. We attempted to occlude the small branch including the perforation site with an autologous blood clot via a wire microcatheter inserted into the small branch. The autologous blood clot was suspended in contrast media and saline. Using this procedure, the small branch of segment 9 was occluded completely and the perforated site was repaired. After the procedure, no significant CPK elevation was detected, and 6 months later, we confirmed that small branch embolization was improved and coronary flow was good. Autologous blood clot is useful to occlude and repair perforations in small side branches of the coronary artery without myocardial damage.
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