Failed thrombin treatment due to patent collateral leakage after refractory guidewire-induced coronary artery...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Ellis class III coronary artery perforation is a severe complication of percutaneous coronary intervention (PCI).
• This complication is associated with high mortality and adverse patient outcomes.
• Guidewire manipulation is a common cause of coronary artery perforation during PCI.

Observation:

• A case of coronary artery perforation caused by a stiff hydrophilic guidewire during PCI is presented.
• Despite successful embolization of the perforated artery, leakage persisted due to patent collaterals.
• The patient underwent cardiac surgery but ultimately died from a left ventricular pseudoaneurysm rupture.

Findings:

• Stiff hydrophilic guidewires pose a risk for coronary artery perforation.
• Persistent leakage from collaterals can occur even after successful vessel occlusion.
• Left ventricular pseudoaneurysms are a potential fatal sequela of coronary artery perforation.

Implications:

• Careful guidewire selection and technique are crucial during PCI to prevent perforation.
• Management strategies for persistent leakage and pseudoaneurysm formation require further investigation.
• This case underscores the catastrophic potential of Ellis class III coronary artery perforation.