Key result
PK Papyrus covered stenting with fenestration successfully seals ostial LCx perforation and restores LAD flow.
Why the study?
Coronary artery perforation is a rare complication of PCI and management strategies including covered stent use and fenestration techniques require further description.
Case Report (n=1)
Fenestration of a covered stent deployed across a major bifurcation can successfully restore flow to an acutely occluded side branch while effectively sealing a coronary perforation.
May serve as bailout for bifurcation perforations; hypothesis-generating and requires prospective validation before adoption.
Coronary artery perforation is a rare complication of percutaneous coronary intervention (PCI). Covered stents have been successfully used in these situations. We report a case of ostial left circumflex (LCx) artery perforation during rotablation PCI of left main coronary artery (LMCA) and LCx artery. After failed attempts to balloon tamponade the perforation, a PK Papyrus covered stent was deployed from proximal LCx into LMCA. This resulted in acute exclusion of the left anterior descending (LAD) artery from coronary circulation. Using a dual lumen catheter, a stiff wire was advanced through the side port toward the occluded LAD to fenestrate the membrane of the covered stent. A series of balloons were used to dilate the fenestration in the covered stent to restore a normal flow into the LAD.
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Adusumalli et al. (2019) conducted a case report in Coronary artery perforation (n=1). PK Papyrus covered stent deployment and fenestration was evaluated on Restoration of normal flow into the LAD. Deployment of a PK Papyrus covered stent followed by fenestration successfully treated an ostial left circumflex artery perforation and restored normal flow to the left anterior descending artery.
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