Closed-Needle Abdominal Micro-Suction Fat Embolization for Distal Coronary Perforation

Distal coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) is traditionally managed with embolic coils or autologous fat. However, fat embolization can be technically demanding due to complex tissue harvesting and delivery. We describe a closed-needle lower abdominal micro-suction technique enabling rapid percutaneous harvesting and direct microcatheter delivery of an autologous fat suspension without benchtop processing. An 18-gauge angiographic needle attached to a syringe pre-loaded with 2-3 mL of a 1:1 contrast-saline mixture is inserted into lower abdominal subcutaneous tissue under continuous manual negative pressure, aspirating 1-2 mL of fat-containing tissue fragments within ~10 s (total final volume ~3.5-5 mL). The resulting radiopaque suspension is delivered directly through a microcatheter using an inverted-syringe technique via small, incremental hand boluses of 0.25-0.5 mL until complete sealing is achieved. Descriptive histology confirmed mature adipose tissue fragments admixed with blood, fibrin, and clot. The technique was successfully deployed in two consecutive patients with Ellis type II and III distal CAP. Immediate angiographic sealing was achieved in both cases without open tissue processing or syringe-to-syringe transfer. At 6-month follow-up, both patients remained clinically stable without recurrent pericardial effusion or target-vessel failure. Closed-needle abdominal micro-suction is a rapid, low-resource, zero-transfer bailout technique for autologous fat embolization in high-acuity distal CAPs.