Why the study?
Managing coronary perforation under anticoagulation presents a clinical dilemma regarding how to preserve vessel patency while addressing the perforation.
This case demonstrates the successful use of advanced PCI techniques, including the ping-pong strategy and coil embolization, to manage coronary perforation and pseudoaneurysm without reversing anticoagulation.
Illustrates perforation management with tamponade and drainage; leaves open optimal anticoagulation resumption in such cases.
Managing coronary perforation under anticoagulation presents a clinical dilemma. This case explores the challenge of preserving vessel patency while addressing perforation. A 76-year-old woman presented with acute chest pain and inferior ST-segment depression. Angiography revealed a small-caliber right coronary artery with faint collateral flow. During percutaneous coronary intervention, an Ellis type III perforation occurred, managed with balloon tamponade and pericardiocentesis. Using the ping-pong technique, flow was restored without reversing anticoagulation. A pseudoaneurysm developed at the perforation site, which was treated successfully with coil embolization. This case highlights the balance required between bleeding risk and ischemic burden in acute coronary syndrome. It underscores the importance of advanced percutaneous coronary intervention techniques like the ping-pong strategy for effective intervention and management of complications such as pseudoaneurysms.
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Sarwar et al. (2025) studied this question.
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