Korean Circ J.  2011 Aug;41(8):474-478. 10.4070/kcj.2011.41.8.474.

Is a Metallic Microcoil Really a Permanent Embolic Agent for the Management of Distal Guidewire-Induced Coronary Artery Perforation?

• Kim JH
• Kim MK
• Kim YJ
• Park SM
• Park KH
• Choi YJ

• KMID: 1826356
• DOI: http://doi.org/10.4070/kcj.2011.41.8.474

Abstract

Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but serious complication. It can cause cardiac tamponade, acute myocardial infarction or death. The treatments of CAP involve prolonged balloon inflation, emergent surgery, coil embolization, and implantation of covered stent. We have successfully performed the emergent microcoil embolization in a patient with uncontrolled Ellis grade 3 guidewire-induced CAP resulting in delayed cardiac tamponade. Contrasting our usual expectation, the 1-year follow-up angiography showed a patent flow at the embolized site.

Keyword

Embolization, therapeutic; Cardiac tamponade; Angioplasty, balloon, coronary

MeSH Terms

Angiography
Angioplasty, Balloon, Coronary
Cardiac Tamponade
Coronary Vessels
Embolization, Therapeutic
Follow-Up Studies
Humans
Inflation, Economic
Myocardial Infarction
Percutaneous Coronary Intervention
Stents

Figure

• 

  Fig. 1 Angiograms obtained during percutaneous coronary intervention. A: AP cranial view of the left anterior descending artery (LAD), showing a severe stenosis (black arrow) at the middle portion, just distal to the first diagonal branch (D1). B: view after 4.0×15 mm Zotarolimus-eluting stent was inserted at the middle LAD, showing a tight narrowing (white arrow) at the ostium of D1. C: kissing balloon angioplasty for LAD with a 3.5×15 mm Sprinter semi-compliant balloon and a 3.0×15 mm Sprinter balloon for D1. D: final angiogram.

• 

  Fig. 2 An emergent and 1-year follow-up coronary angiogram. A: coronary artery perforation, evidenced by contrast leak into the pericardium from the distal end of the diagonal branch (D1) of left anterior descending artery (area marked by white triangles). B: embolization of D1 by helical microcoil (white arrow), with no evidence of contrast leak. C: showing surprising patent flow at the embolized site of D1 on the follow-up angiogram.

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