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Managing a Right Coronary Artery Perforation, Pseudoaneurysm, and the Fight for Patency

Year: 2025

Type: article

Abstract: Managing coronary perforation under anticoagulation presents a clinical dilemma. This case explores the challenge of preserving vessel patency while addressing perforation. A 76-year-old woman presented with acute chest pain and inferior ST-segment depression. Angiography revealed a small-caliber right coronary artery with faint collateral flow. During percutaneous coronary intervention, an Ellis type III perforation occurred, managed with balloon tamponade and pericardiocentesis. Using the ping-pong technique, flow was restored without reversing anticoagulation. A pseudoaneurysm developed at the perforation site, which was treated successfully with coil embolization. This case highlights the balance required between bleeding risk and ischemic burden in acute coronary syndrome. It underscores the importance of advanced percutaneous coronary intervention techniques like the ping-pong strategy for effective intervention and management of complications such as pseudoaneurysms.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2024.103092

Authors: Maruf Sarwar, Stephen D. Adedokun, Keonmin Hwang, Mahesh Anantha Narayanan

Institutions: University of Tennessee Health Science Center, Belmont University, University of Arkansas for Medical Sciences

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850