First-in-Human Use of a Novel Perfusion-Channel Drug-Coated Balloon to Manage Coronary Artery Perforation During...

Coronary artery perforation (CAP) remains a serious complication of percutaneous coronary intervention (PCI), with an increased incidence during chronic total occlusion (CTO) procedures. Conventional management using covered stents often compromises side branches and limits future revascularization options, while prolonged balloon inflation, though simpler, interrupts distal flow and increases ischemic risk. We present a case of a 54-year-old male with coronary heart disease, hypertension, and diabetes who underwent PCI for a severe proximal stenosis and a mid-segment CTO of the left anterior descending artery (LAD). Following small balloon predilation, an Ellis type II perforation occurred in the LAD main vessel region. A novel perfusion-channel drug-coated balloon (PcDCB) was immediately deployed, covering the proximal LAD and the ostium of a large diagonal branch (D1). Inflation at 6 atm for 10 minutes successfully sealed the perforation while maintaining TIMI 2 flow into D1 via its side channels. Post-procedural angiography and echocardiography confirmed complete sealing without pericardial effusion. This first-in-human experience demonstrates that the PcDCB can effectively manage CAP by achieving simultaneous mechanical sealing and distal perfusion, and in this case additionally treated a severely stenotic proximal segment, potentially avoiding stent implantation while preserving the option for future staged revascularization. The drug-coated property may offer added rationale for treating diseased segments, though its specific role in perforation management per se warrants further investigation.