Korean Circ J.  2010 Mar;40(3):148-151. 10.4070/kcj.2010.40.3.148.

Coronary Artery Perforation Following Implantation of a Drug-Eluting Stent Rescued by Deployment of a Covered Stent in Symptomatic Myocardial Bridging

• Zhang M
• Kang WC
• Moon CI
• Han SH
• Ahn TH
• Shin EK

• KMID: 2094077
• DOI: http://doi.org/10.4070/kcj.2010.40.3.148

Abstract

We successfully rescued a patient whose coronary artery perforated following implantation of a drug-eluting stent (DES), by deploying a stent-graft in symptomatic myocardial bridging. Our case demonstrated that coronary perforation could be handled without difficulty when perforated myocardial bridging is confined to the interventricular groove

Keyword

Myocardial bridging; Drug eluting stents; Angioplasty, Transluminal, percutaneous coronary

MeSH Terms

Angioplasty, Balloon, Coronary
Coronary Vessels
Drug-Eluting Stents
Humans
Myocardial Bridging
Stents

Figure

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  Fig. 1 A: angiography revealed 80% stenosis aggravated by severe muscular bridging at the mid LAD. B: at a nominal pressure of, the stent was not fully expanded in the middle segment of the lesion. So, we inflated the stent with a high pressure, up to 16 atm. C: on follow-up angiography, the coronary artery was perforated and extravasation of contrast into the pericardium was noted at the site of the lesion. D: an IVUS study showed the perforation site and a perivascular hematoma along the lesion. E: after implantation of a covered stent, leaking flow from the coronary lesion was no longer noted. F: follow-up echocardiography showed a minimal amount of pericardial effusion (arrow) without hemodynamic instability. LAD: left anterior descending, IVUS: intravascular ultrasound.

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  Fig. 2 A and B: four months after the stent procedure, CT angiography showed no evidence of residual hematoma or pseudoaneurysm (arrow). C: follow-up coronary angiography performed at 8 months after the procedure showed good distal flow with minimal stenosis at the proximal edge of the stent (arrow).

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