Persistent type III cavity-spilling coronary perforation due to covered stent malapposition

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Medical Device Technology

Background:

• Percutaneous coronary intervention (PCI) carries a risk of rare but severe complications.
• Coronary artery perforation, particularly large or cavity-spilling types, presents significant management challenges.

Observation:

• A case of a large, cavity-spilling perforation of the left anterior descending artery into the left ventricle occurred during PCI.
• Initial treatment involved the successful deployment of a covered stent to seal the perforation.

Findings:

• Repeat angiography one week post-procedure showed persistent perforation.
• The persistence was attributed to malapposition of the deployed covered stent.

Implications:

• Covered stents are a viable option for managing coronary artery perforations.
• Stent malapposition can compromise the efficacy of covered stents, necessitating careful post-procedural assessment.
• Further research into optimal stent deployment and imaging techniques for covered stents in perforation management is warranted.