An alternative treatment strategy for large vessel coronary perforations

Area of Science:

• Interventional Cardiology
• Vascular Surgery

Background:

• Large vessel coronary perforations are a complication during percutaneous coronary intervention (PCI).
• Standard treatment involves covered stent implantation.
• Chronic total occlusion (CTO) PCI presents unique challenges for managing perforations.

Observation:

• Antegrade attempts to cross a right coronary artery CTO led to guidewire/microcatheter exit and pericardial bleeding.
• Temporary hemostasis was achieved by inflating a balloon proximal to the perforation.
• Retrograde crossing of the CTO was accomplished using epicardial collaterals via a specific tracking technique.

Findings:

• Stent implantation successfully achieved hemostasis.
• A subintimal flap created by the stent likely sealed the perforation site.
• Subintimal recanalization emerged as a potential alternative strategy.

Implications:

• Subintimal recanalization may offer a viable alternative to covered stents for coronary perforations during CTO PCI.
• This approach could expand treatment options for complex coronary artery disease.
• Further research is warranted to establish the safety and efficacy of this technique.