Delayed Coronary Artery Perforation of a Nontarget Distal Small Side Branch With Subsequent Cardiac Tamponade After...

Coronary artery perforations (CAPs) during percutaneous coronary interventions (PCIs) are rare and potentially fatal complications. Delayed CAPs are extremely rare. Here, we report a case of a delayed CAP in a small side branch that was not the target vessel of the PCI, which was difficult to salvage and was caused by a hydrophilic guidewire during PCI for bifurcation lesions. Finally, intracoronary administration of gelatin microspheres resulted in complete occlusion of the CAP site. Although the mechanism(s) of the delayed CAP onset had not been entirely elucidated, its pathogenesis is believed to have been multifocal. The key factors contributing to the delayed CAP may have included the nimious platelet-suppressing effects of dual-antiplatelet therapy, the prolonged anticoagulant effect of heparin used during PCI, the use of stiff-tip and hydrophilic guidewires, inadvertent guidewire advancement into small coronary arteries, and the fragility of coronary arteries associated with coronary risk factors. Meticulous attention to any patient signs, symptoms, or a nimble definite diagnosis, and effective, timely management of delayed CAPs may be essential for practicing cardiologists to reduce subsequent complications and improve patient prognosis after PCI, especially in cases of complex lesions.