Book review
https://doi.org/10.20471/acc.2024.63.s1.9
Percutaneous Coronary Intervention of the Small Diagonal Branch in Acute Myocardial Infarction without ST Elevation Complicated by Coronary Artery Perforation and Cardiac Tamponade
Martina Čančarević
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia
*
Vjekoslav Radeljić
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia; The School of Medicine of the University of Zagreb, Zagreb, Croatia
Matias Trbušić
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia; The School of Medicine of the University of Zagreb, Zagreb, Croatia
Zdravko Babić
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia; The School of Medicine of the University of Zagreb, Zagreb, Croatia
Ivan Zeljković
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia; The School of Medicine of the University of Zagreb, Zagreb, Croatia
Nikola Kos
; Sestre milosrdnice University Hospital, Department of Cardiovascular Diseases, Zagreb, Croatia
* Corresponding author.
Abstract
Introduction: Small coronary artery disease is more common in elderly patients,
smokers, patients with diabetes and chronic kidney disease. Percutaneous interventions on small coronary
arteries are associated with an increased risk of complications (perforation, dissection and restenosis).
Coronary artery perforation treatment includes cover stents and coil placement.
Case report: A 73-year-old patient, without comorbidities, was hospitalized for acute non ST-elevation
myocardial infarction. Coronary angiography showed subocclusion of the first diagonal branch
(culprit lesion) while the other epicardial coronary arteries were without stenosis. Multiple predilatations
of the target vessel were performed, and as it was a vessel with a diameter of less than 2 mm, no stent was
placed. The final angiogram showed normal flow and good morphological result. Half an hour after the
procedure, cardiac tamponade and cardiorespiratory arrest developed. Emergency pericardiocentesis was
performed and after the return of spontaneous circulation, emergency recoronarography was performed.
It showed perforation of the diagonal branch with contrast extravasation. Coronary coil was applied proximal
to the perforation site. Perforation repair and hemodynamic stabilization were achieved.
Conclusion: Coronary artery perforation is a life-threatening complication of percutaneous coronary
intervention. The risk of perforation is higher in the case of small coronary arteries; it can be presented by
delayed cardiac tamponade, which requires increased supervision of the patient.
Keywords
Small coronary arteries; Coronary artery perforation; Cardiac tamponade
Hrčak ID:
320972
URI
Publication date:
1.3.2024.
Visits: 0 *