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The Interventional "Backstop": The Stent-Mid-Perforation Coiling Technique for Large Distal Coronary Perforations
Syed H Haq1, Sidra R Shah1, Amanda Laird2
1Department of Internal Medicine, BonSecours Mercy Health, St. Rita's Medical Center, Lima, Ohio, USA.
Insights
Large distal coronary perforations (DCP) causing cardiac tamponade after percutaneous coronary intervention (PCI) can be challenging. A novel stent-mid-perforation and coiling technique successfully treated a complex DCP case unresponsive to standard methods.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery perforations (CAP) are potential complications of percutaneous coronary intervention (PCI).
- Distal coronary perforations (DCP) present unique challenges due to anatomical constraints and rapid progression.
- Conventional treatments like endovascular coils may be limited by perforation size, anatomy, or equipment issues.
Abstract:
Coronary artery perforations (CAP) presentations following percutaneous intervention (PCI) may vary depending on the size and location of the injured vessel. Distal coronary perforations (DCP) can rapidly progress, making treatment notoriously challenging. Endovascular coils have frequently been utilized for DCP. Unfortunately, anatomical restrictions, the size of perforation, or equipment deficiencies can complicate deployment. We present a case of large DCP complicated by acute cardiac tamponade that was unamenable to conventional methods. This was successfully treated with a drug-eluting stent (DES) through the perforation into the pericardium and the placement of endovascular coils within the stent, that is, the stent-mid-perforation (and coiling) technique.
