Author + information
- Received March 2, 2015
- Accepted March 12, 2015
- Published online August 24, 2015.
- Shingo Yamamoto, MD,
- Kenichi Sakakura, MD∗ (, )
- Hiroshi Funayama, MD,
- Hiroshi Wada, MD,
- Hideo Fujita, MD and
- Shin-ichi Momomura, MD
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Omiya Saitama City, Japan
- ↵∗Reprint requests and correspondence:
Dr. Kenichi Sakakura, Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya Saitama City 330-8503, Japan.
- coronary perforation
- covered stent
- percutaneous coronary intervention
- perfusion balloon
- rotational atherectomy
A 70-year-old woman who had 3 tandem stenoses with severe calcification in a large tortuous right coronary artery (RCA) (Figure 1A) underwent percutaneous coronary intervention. Type 3 coronary perforation occurred following rotational atherectomy (1.25-mm burr, 140,000 rotations/min) (Figure 1B) (1). First, we used a 3.0 × 15 mm semicompliant balloon to clamp the RCA ostium, and then we used a 2.5-mm perfusion balloon (Ryusei, Kaneka Medix, Osaka, Japan). Although pericardiocentesis was performed successfully, her systemic blood pressure was not restored, probably due to sudden ischemia of the dominant RCA. A total of 3 covered stents (GraftMaster 2.8 × 16 mm, Abbott Vascular, Abbott Park, Illinois) were successfully implanted to cover the perforation (Figures 1C to 1E). Two bare-metal stents were added proximal (4.0 × 23 mm) and distal (4.0 × 26 mm) to the covered stents, and post-dilation was performed using a 4.0-mm noncompliant balloon to dilate the covered stents. Her blood pressure recovered following successful stent implantation (Figure 1F).
She discharged on foot at day 13 following percutaneous coronary intervention, and her left ventricular systolic function was normal without segmental asynergy. Multislice computed tomography (Aquilion One, Toshiba, Tokyo, Japan) was performed at 2 months following percutaneous coronary intervention. Surprisingly, the covered stents created a bypass for the ruptured RCA and shell of RCA (Figures 2A and 2B), which suggests a part of the guidewire was totally outside of the RCA vessel. Although some coronary perforation can be repaired by the long inflation of the perfusion balloon (2), the perfusion balloon would never repair this kind of perforation. Our case suggests that there is a definite indication of covered stents for type 3 coronary perforation.
Dr. Sakakura has received speaking honorarium from Abbott Vascular, Boston Scientific, Daiichi-Sankyo, Sanofi, Terumo, and Medtronic Cardiovascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 2, 2015.
- Accepted March 12, 2015.
- American College of Cardiology Foundation