ST-elevation myocardial infarction caused by coronary artery compression due to localized pericardial hematoma caused
Carlos Cafri1, Aryeh Shalev, Doron Zahger
1Cardiology Department, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
The Journal of Invasive Cardiology
|November 3, 2010
Insights
Coronary perforation during percutaneous coronary intervention (PCI) can cause myocardial infarction. This case highlights a rare cause: guidewire perforation leading to hematoma and artery compression.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Coronary perforation is a rare but significant complication of PCI.
- Post-cardiac surgery patients may have unique anatomical considerations during PCI.
Observation:
- A patient with a history of cardiac surgery presented with ST-segment elevation myocardial infarction (STEMI).
- The STEMI was found to be secondary to compression of an epicardial artery.
- The compression was caused by a localized hematoma resulting from guidewire-induced coronary perforation during PCI.
Findings:
- Guidewire-induced coronary perforation is a potential cause of STEMI in post-cardiac surgery patients.
- Hematoma formation secondary to perforation can lead to external compression of coronary arteries.
- Unusual presentations of myocardial infarction can occur due to rare complications of interventional procedures.
Implications:
- This case underscores the importance of recognizing rare complications of PCI, even in complex patient populations.
- Careful guidewire manipulation is crucial to prevent coronary perforation.
- Prompt diagnosis and management of coronary perforation and its sequelae are vital for patient outcomes.
Abstract:
Coronary perforation is a rare but serious complication of percutaneous coronary intervention (PCI). We report a case of coronary perforation during PCI in a post cardiac surgery patient presenting as unusual ST-segment elevation myocardial infarction, secondary to compression of an epicardial artery by a localized hematoma, secondary to coronary perforation by the guidewire.
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