Left main perforation and acute stent thrombosis--a cath lab nightmare

Coronary perforation is a rare, but life-threatening, complication that can develop during a percutaneous coronary intervention (PCI). Prompt nonsurgical treatment such as covered stent deployment can potentially arrest progression of the condition; however, other lethal complications such as acute stent thrombosis or side branch occlusion can occur. This report describes a case of perforation of the left main coronary artery that was successfully managed via stenting; however, acute stent thrombosis and side branch occlusion subsequently occurred under extracorporeal membrane oxygenation support. Means of avoiding this tragic outcome involve the routine use of intravascular ultrasound in patients undergoing PCI of the left main coronary artery, being respectful of circumferential calcification, and keeping the procedure as simple as possible.