Late coronary artery perforation with subsequent cardiac tamponade 3 days after primary percutaneous coronary intervention in a young woman with spontaneous coronary artery dissection - induced ST-elevation myocardial infarction: A case report

Background Spontaneous coronary artery dissection (SCAD) is an important cause of ST-elevation myocardial infarction (STEMI), which affects young women. Treatment with percutaneous coronary intervention (PCI) is indicated in clinically and hemodynamically unstable patients. Late coronary artery perforation (CAP) is an uncommon, but potentially fatal complication of a PCI that can occur 30 minutes to 9 days after the procedure. Case summary A 40-year-old woman was admitted to our hospital with STEMI. Coronarography showed a type 2A SCAD of the LAD. We proceeded with PCI-stenting and the result appeared optimal. After three days of uneventful postinterventional stay, the patient became hypotensive and clinically unstable, with echocardiography revealing a cardiac tamponade. We performed an urgent pericardiocentesis and coronarography, detecting a type 3 coronary artery perforation of the LAD in-stent, which we covered with a graft stent. Following the intervention, the patient had pericardial inflammation for the next month with intermittent fever and persisting pericardial effusion. After administering Colchicine for 3 months, the effusion completely subsided, with control echocardiographies showing normal pericardium. Discussion PCI in patients with SCAD-induced STEMI can be challenging and has a risk of complications. Late CAP is a rare complication that can easily be overlooked, especially when we think that the result of the intervention was optimal. In our case, we think that the cause of CAP is the post-dilatation with a high-pressure non-compliant balloon. The goal of this case report is to remind us of the possibility of CAP even if three days have passed following the procedure.