Cor Vasa 2015, 57(5):e334-e340 | DOI: 10.1016/j.crvasa.2015.05.011

Coronary artery perforation: How to treat it?

Davide Piraino^a, Gregory Dendramis^b,*, Dario Buccheri^a, Claudia Paleologo^b, Giulia Teresi^b, Antonino Rotolo^b, Giuseppe Andolina^a, Pasquale Assennato^b

^a Division of Cardiology, Department of Internal Medicine and Cardiovascular Diseases, Section of Interventional Cardiology and Hemodynamics, University Hospital "Paolo Giaccone", Palermo, Italy

^b Division of Cardiology, Department of Internal Medicine and Cardiovascular Diseases, Section of Intensive Coronary Care Unit, University Hospital "Paolo Giaccone", Palermo, Italy

Coronary artery perforation fortunately represents a rare complication of coronary catheterization but, if not properly and promptly treated, it is burdened by a high mortality rate. Rates of coronary perforation may be potentially higher when atherectomy devices are used or very complex calcified lesion are treated. Cardiac tamponade constitutes the most severe clinical consequence.
We report a case of an intra-stent coronary perforation at the end of revascularization of a non ST elevation myocardial infarction (NSTEMI), followed by an immediate impairment of hemodynamic compensation due to significant pericardial effusion and subsequent cardiac tamponade.
The use of covered stents has revolutionized the management of coronary perforation and this has meant that the use of emergency CABG has decreased over the years with satisfactory immediate and short-term outcomes, reducing the incidence of acute cardiac tamponade and mortality without surgery.

Keywords: Coronary perforation; Covered stent; Intra-aortic balloon pump; Myocardial infarction; Percutaneous coronary intervention

Received: March 28, 2015; Revised: May 13, 2015; Accepted: May 15, 2015; Published: October 1, 2015  Show citation