Reversing intraprocedural heparin with protamine to manage iatrogenic coronary arteriovenous fistula during PCI carries a high risk of extensive coronary artery thrombosis.
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Protamine reversal for iatrogenic coronary fistula risks extensive thrombosis; case report leaves optimal PCI management open.
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
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Wilsmore et al. (2009) studied this question.
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