Key result
Gelfoam embolization successfully sealed a distal small diagonal branch perforation (<2 mm) and prevented impending cardiac tamponade after failed balloon inflation.
Case Report (n=1)
Gelfoam embolization is a viable rescue strategy for small vessel (<2 mm) coronary perforations when traditional covered stents are not available in size.
May offer bailout for refractory small-vessel perforation; hypothesis-generating and leaves open need for prospective validation.
We report a rare case of inadvertent distal small diagonal branch perforation noted postleft anterior descending coronary artery revascularization, rescued by Gelfoam closure in a 43-year diabetic male presenting with acute anterior wall ST elevated myocardial infarction. Intermittent balloon inflation for 30 min was not able to seal off the perforation; because of impending late (3–6 h) cardiac tamponade, we closed the perforation with Gelfoam embolization through Caravel microcatheter. Although rarely practiced, this armamentarium should be there in the interventional cardiology laboratory to deal with small vessel perforation (<2 mm), for which traditionally covered stents are not available in size.
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Das et al. (2021) conducted a case report in Coronary perforation during STEMI revascularization (n=1). Gelfoam embolization was evaluated on Sealing of perforation. Gelfoam embolization successfully sealed a distal small diagonal branch perforation (<2 mm) and prevented impending cardiac tamponade after failed balloon inflation.
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