Homemade stent shields: fortifying against coronary perforation in STEMI patients amidst intensive glycoprotein...

Coronary artery perforation (CAP), though rare, is a serious complication of percutaneous coronary intervention (PCI) that demands prompt, tailored management. Swift recognition and intervention are essential. Typically, a covered stent is used to seal the perforation and restore vessel integrity. However, if unavailable, a homemade covered stent can be crafted and deployed. The choice of treatment depends on bleeding severity, patient stability, and available resources.

A 70-year-old male with a history of diabetes and hypertension presented with severe chest pain persisting for 7-8 h, radiating to the left arm and jaw, accompanied by diaphoresis and nausea. His baseline electrocardiogram revealed an extensive anterior wall myocardial infarction, prompting immediate transfer to the catheterization laboratory for primary PCI. During the procedure, an unfortunate complication of CAP leading to cardiac tamponade was successfully managed by pericardiocentesis. With the unavailability of commercial covered stents, an improvised covered stent was fashioned and deployed, effectively sealing the perforation despite ongoing administration of glycoprotein IIb/IIIa inhibitors and heparin which was initiated following acute stent thrombosis. The patient's haemodynamic status stabilized during hospitalization, and he was discharged in a stable condition.

Our case is a pioneering instance of using a homemade stent with glycoprotein IIb/IIIa inhibitors and heparin in a STEMI patient with CAP. This novel approach was successful, demonstrating its feasibility and safety. Our experience suggests that improvised stenting techniques could be a viable option in complex coronary interventions, especially when commercial alternatives are unavailable. Further validation may broaden treatment options and improve outcomes in interventional cardiology.