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PERCUTANEOUS CORONARY INTERVENTION OF THE SMALL DIAGONAL BRANCH IN ACUTE MYOCARDIAL INFARCTION WITHOUT ST ELEVATION
Martina Čančarević1, Vjekoslav Radeljić1,2, Matias Trbušić1,2
1Sisters of Charity University Hospital, Department of Cardiovascular Diseases, Vinogradska cesta 29, Zagreb, Croatia.
Insights
Coronary artery perforation during percutaneous coronary intervention is a serious risk, especially in small vessels. Prompt coil placement successfully repaired a perforation, stabilizing a patient with myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Small coronary artery disease (CAD) is prevalent in elderly, diabetic, and kidney disease patients.
- Percutaneous coronary interventions (PCI) in small coronary arteries (<2mm) carry higher risks of complications like perforation, dissection, and restenosis.
Observation:
- A 73-year-old patient presented with acute non ST-elevation myocardial infarction.
- Coronary angiography revealed a culprit lesion in a small diagonal branch (<2mm).
- Following predilatation without stenting, the patient developed delayed cardiac tamponade and cardiorespiratory arrest.
Findings:
- Emergency coronary angiography identified a perforation in the diagonal branch with contrast extravasation.
- Successful treatment involved proximal coil placement to repair the perforation.
- The intervention led to hemodynamic stabilization and return of spontaneous circulation.
Implications:
- Coronary artery perforation is a critical PCI complication, particularly in small vessels.
- Delayed cardiac tamponade necessitates vigilant patient monitoring post-PCI.
- Coil embolization is an effective treatment for coronary artery perforation, averting catastrophic outcomes.
Introduction:
Small coronary artery disease is more common in elderly patients, smokers, patients with diabetes and chronic kidney disease. Percutaneous interventions on small coronary arteries are associated with an increased risk of complications (perforation, dissection and restenosis). Coronary artery perforation treatment includes cover stents and coil placement.
Case Report:
A 73-year-old patient, without comorbidities, was hospitalized for acute non ST-elevation myocardial infarction. Coronary angiography showed subocclusion of the first diagonal branch (culprit lesion) while the other epicardial coronary arteries were without stenosis. Multiple predilatations of the target vessel were performed, and as it was a vessel with a diameter of less than 2 mm, no stent was placed. The final angiogram showed normal flow and good morphological result. Half an hour after the procedure, cardiac tamponade and cardiorespiratory arrest developed. Emergency pericardiocentesis was performed and after the return of spontaneous circulation, emergency recoronarography was performed. It showed perforation of the diagonal branch with contrast extravasation. Coronary coil was applied proximal to the perforation site. Perforation repair and hemodynamic stabilization were achieved.
Conclusion:
Coronary artery perforation is a life-threatening complication of percutaneous coronary intervention. The risk of perforation is higher in the case of small coronary arteries; it can be presented by delayed cardiac tamponade, which requires increased supervision of the patient.
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