Unusual case of coronary perforation which developed delayed cardiac tamponade due to collateral flow from contralateral
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CASE REPORT
Unusual case of coronary perforation which developed delayed cardiac tamponade due to collateral flow from contralateral coronary artery Yuichi Ozaki • Hironori Kitabata • Takashi Akasaka
Received: 29 December 2011 / Accepted: 6 May 2012 / Published online: 19 June 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract Coronary artery perforation is a rare but catastrophic complication of percutaneous coronary intervention (PCI). PCI for chronic total occlusion (CTO) lesions is associated with lower procedural success rate and higher incidence of complications as compared with non-CTO coronary vessels. Here we report a rare case of a patient who developed coronary perforation during PCI for the CTO lesion and suffered from delayed cardiac tamponade due to collateral flow from the contralateral coronary artery despite complete hemostasis of the perforated site by the covered stent. Keywords Cardiac tamponade Chronic total occlusion Collateral artery Percutaneous coronary intervention Perforation
Introduction Coronary artery perforation is a rare complication related to percutaneous coronary intervention (PCI), occurring in only 0.2–0.5 % of cases [1, 2]. However, coronary artery perforation can result in cardiac tamponade, myocardial infarction, and death [3]. Chronic total occlusion (CTO) is a frequent finding in patients with coronary artery disease and remains one of the most challenging target lesion subtypes for PCI. CTO lesions have been reported in approximately one-third of Y. Ozaki H. Kitabata T. Akasaka (&) Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan e-mail: [email protected] Y. Ozaki e-mail: [email protected]
patients undergoing diagnostic coronary angiography [4]. Because of the technical and procedural complexities, PCI for CTO lesions is associated with lower procedural success rate, higher incidence of complications, greater radiation exposure, and longer procedure time as compared with PCI for non-CTO coronary vessels [5, 6]. Here we present a rare case of a patient who suffered from cardiac tamponade due to filling from collateral artery to the perforated site after hemostasis by covered stent implantation was completely confirmed on the angiogram. This case report and discussion would be helpful for the readers to deal with life-threatening complications during PCI.
Case presentation A 79-year-old woman with hypertension was admitted to our hospital with 2 months history of effort angina pectoris. Coronary angiography (CAG) showed total occlusion of the mid left anterior descending artery (LAD) (Fig. 1a) with collateral vessels from the conus branch and right ventricular (RV) branch of the right coronary artery (RCA) (Fig. 1b). Because exercise 201-thallium scintigram revealed inducible myocardial ischemia in the LAD territory, PCI to the LAD lesion was attempted. A 6-Fr Judkins-type catheter via the femoral approach was used to engage the left coronary a
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