Catastrophic Left Main Coronary Artery Perforation During Complex Percutaneous Coronary Intervention: Successful
Satoru Sumitsuji1, Kenji Sadamatsu2
1Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Future Medicine, Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Intravascular ultrasound (IVUS) can cause rare coronary perforations. Rapid extracorporeal membrane oxygenation (ECMO) and a heart team approach saved a patient with cardiac arrest from IVUS-induced coronary perforation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Complications
Background:
- Intravascular ultrasound (IVUS) is used in percutaneous coronary interventions (PCIs).
- IVUS-related coronary perforations are infrequent but severe complications.
- These perforations can lead to life-threatening events like cardiac arrest.
Background:
Intravascular ultrasound (IVUS)-related coronary perforations are rare but life-threatening complications of percutaneous coronary interventions.
Case Summary:
An older woman underwent percutaneous coronary intervention for a severely calcified stenosis in the proximal left anterior descending artery. During IVUS advancement after rotational atherectomy, a longitudinal coronary perforation occurred, resulting in cardiac arrest. Rapid deployment of venoarterial extracorporeal membrane oxygenation (ECMO) was initiated, followed by multiple covered stents and emergency coronary artery bypass grafting.
Discussion:
Although balloon hemostasis and pericardiocentesis had not yet been performed, no signs of tamponade on fluoroscopy made us decide on the initial ECMO deployment, which resulted in an excellent outcome without significant myocardial damage and neurologic deficits.
Take-Home Messages:
Rapid ECMO and a multidisciplinary heart team approach are vital for rescuing lives without serious sequelae. In addition, careful IVUS manipulation and thorough evaluation are essential in high-risk coronary interventions.
