Key result
Emergency pericardiocentesis, prolonged balloon inflation, and PTFE graft stenting successfully seal Ellis type III perforation.
Why the study?
Coronary perforation during PCI is a rare but potentially fatal complication with urgent need for effective management of cardiac tamponade.
Case Report (n=1)
May offer bailout for Ellis III perforation; leaves open need for prospective validation.
Coronary perforation is a rare, but potentially fatal complication of percutaneous coronary intervention with mortality in 7-8 % of cases. Cardiac tamponade after coronary perforation is a result of rapid blood accumulation in pericardial space. It is urgent, life-threatening condition which requires quick diagnosis and pericardiocentesis. In 76 years-old patient, Ellis type III perforation occured after stent implantation in proximal segment of circumflex branch of left coronary artery. It was treated with intravenous administration of protamine-sulfate, prolonged balloon inflation and implantation of polytetrafluoroeth-ylene stent graft. After echo confirmation of significant pericardial effusion with cardiac tamponade, pericardiocentesis was performed and 350ml of blood was removed from pericardial space. Control coronary angiography showed no signs of contrast extravasation. Pericardiocentesis in a life-saving procedure for patients with cardiac tamponade after coronary perforation.
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Kovacevic et al. (2011) conducted a case report in Coronary artery rupture with cardiac tamponade during PCI (n=1). Pericardiocentesis, prolonged balloon inflation, and PTFE stent graft was evaluated. Emergency pericardiocentesis combined with prolonged balloon inflation and a polytetrafluoroethylene stent graft successfully resolved a life-threatening Ellis type III coronary perforation.
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