Work

Catastrophic Left Main Coronary Artery Perforation During Complex Percutaneous Coronary Intervention

Year: 2025

Type: article

Abstract: BACKGROUND: Intravascular ultrasound (IVUS)-related coronary perforations are rare but life-threatening complications of percutaneous coronary interventions. CASE SUMMARY: An older woman underwent percutaneous coronary intervention for a severely calcified stenosis in the proximal left anterior descending artery. During IVUS advancement after rotational atherectomy, a longitudinal coronary perforation occurred, resulting in cardiac arrest. Rapid deployment of venoarterial extracorporeal membrane oxygenation (ECMO) was initiated, followed by multiple covered stents and emergency coronary artery bypass grafting. DISCUSSION: Although balloon hemostasis and pericardiocentesis had not yet been performed, no signs of tamponade on fluoroscopy made us decide on the initial ECMO deployment, which resulted in an excellent outcome without significant myocardial damage and neurologic deficits. TAKE-HOME MESSAGES: Rapid ECMO and a multidisciplinary heart team approach are vital for rescuing lives without serious sequelae. In addition, careful IVUS manipulation and thorough evaluation are essential in high-risk coronary interventions.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2024.103196

Authors: Satoru Sumitsuji, Kenji Sadamatsu

Institutions: The University of Osaka, Omuta City Hospital

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