Distal Coronary Perforation Sealing With Combined Coil and Fat Embolization

Distal coronary perforation is a rare complication of percutaneous coronary intervention. While temporary balloon occlusion of the proximal coronary artery is the first step in perforation management, more definitive treatment options include covered stent implantation for large vessel perforations or fat/coil embolization for distal vessel perforations. We report a case of an 81-year old man who presented with inferior/posterior ST-segment elevation acute myocardial infarction. Coronary angiography showed a 90% distal left circumflex artery (LCx) stenosis. Percutaneous coronary intervention of the culprit vessel was challenging due to balloon uncrossable lesions in LCx and was complicated by distal coronary perforation due to excessive wire movement. Two Axium coils were delivered using a Finecross microcatheter but failed to seal the perforation. We performed fat embolization (proximal to the coils) that successfully sealed the perforation. In selected cases where coil embolization alone fails to seal a distal coronary perforation, combined coil and fat embolization might help achieve hemostasis.