The Interventional "Backstop": The Stent-Mid-Perforation Coiling Technique for Large Distal Coronary Perforations

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.