Intracoronary fiducial embolization after percutaneous placement for stereotactic radiosurgery

Although well established for the treatment of intracranial and prostatic pathology, stereotactic radiosurgery has only recently emerged as a modality for the treatment of malignant lung lesions. Utilization of radio-opaque markers, called fiducials, facilitate dose-intensive radiation focused on the tumor with sparing of surrounding normal tissue. There is a paucity of literature regarding complications that occur secondary to placement of these fiducials. The following report details a case in which intracoronary migration resulted in a hemodynamically significant acute coronary syndrome.