Traumatic Coronary Artery Dissection Treated With Prolonged Perfusion Balloon Inflation

Traumatic coronary artery dissection is a rare complication of blunt chest trauma and may be obscured by concomitant injuries.

A 69-year-old woman struck by a car developed inferior ST-segment elevation on hospital day 17. Angiography showed distal right coronary artery (RCA) occlusion and a long mid-RCA dissection; intravascular ultrasound revealed noncontiguous "skip" lesions. To avoid stenting because of high bleeding risk (HBR) due to subarachnoid hemorrhage, repeated prolonged low-pressure inflations using a perfusion balloon restored coronary flow without stent implantation. Given the HBR and stentless strategy, she was managed on aspirin monotherapy. On postprocedure day 37, coronary computed tomography angiography showed a patent RCA with healing.

This case underscores a stentless strategy using perfusion-balloon-assisted prolonged inflation when HBR precludes dual antiplatelet therapy.

A high index of suspicion for traumatic coronary artery dissection is needed after blunt trauma; perfusion balloon with prolonged inflation can restore flow without stenting in patients with HBR.