Unexpected huge post-stenting coronary perforation during complex left main revascularization

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• A 78-year-old male patient presented with severe coronary artery disease, specifically a tight left main stenosis and extensive calcification in the left anterior descending artery.
• The patient declined surgical intervention, opting for percutaneous coronary intervention (PCI).

Observation:

• Following successful stenting, the patient developed cardiogenic shock attributed to a large coronary artery rupture.
• This complication posed a significant threat to the patient's immediate survival and the success of the revascularization.

Findings:

• Emergency pericardial drainage was performed to manage the hemopericardium.
• Autologous blood reinfusion was utilized without reversing anticoagulation (heparin).
• This strategy facilitated the successful completion of the complex coronary revascularization procedure despite the rupture.

Implications:

• This case highlights the feasibility of managing major coronary artery rupture during PCI with a strategy of drainage and autologous blood reinfusion.
• It suggests that avoiding heparin reversal in specific scenarios may allow for procedural completion, potentially improving outcomes in high-risk patients.
• This approach offers an alternative management pathway for life-threatening complications during complex interventional cardiology procedures.