Coronary rupture after stent deployment in a patient under chronic immunosuppressive therapy

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary artery rupture is a rare but severe complication during cardiac catheterization and angioplasty.
• Predisposing factors for this complication remain incompletely understood.
• Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.

Observation:

• A case of coronary artery rupture during urgent PCI is presented.
• The patient was undergoing chronic immunosuppressive therapy with corticosteroids and azathioprine.
• Intravascular ultrasound (IVUS) guidance was used during the intervention.

Findings:

• Despite optimal IVUS sizing, coronary artery rupture occurred.
• The perforation was initially managed with balloon inflation.
• A covered stent was successfully deployed to seal the rupture.
• This event suggests immunosuppressive therapy may compromise coronary artery wall integrity.

Implications:

• Immunosuppressive therapy might increase the risk of coronary artery wall vulnerability during interventions.
• Healthcare providers should exercise increased caution when performing coronary interventions in patients on immunosuppressants.
• Careful consideration of intracoronary device use is warranted in this patient population.