The patient underwent percutaneous intervention of the LAD and LCX/OM1. A 2.5 × 18 mm microdriver (Medtronic, Minneapolis, MN, USA) bare metal stent (BMS) was deployed at 12 atmospheres (atm) into the LCX/OM1 with thrombolysis in myocardial infarction grade 3 (TIMI 3) flow.
For the LAD lesion, a 2.5 × 18 mm microdriver (Medtronic) BMS was deployed at 14 atm and postdilated with 3.0 × 13 mm power sail balloon (Guidant, Santa Clara CA, USA) at 22–24 atm. Dissections were noted at the proximal and distal edges of the stent. To cover the distal edge dissection a 2.5 × 14 mm microdriver (Medtronic) BMS was deployed at 12 atm. Both stents were postdilated with a 3.0 × 13 mm power sail balloon (Guidant) at 14–24 atm. The proximal edge dissection was covered with a driver 3.0 × 18 mm (Medtronic) BMS deployed at 10 atm. The 3.0 × 18 mm stent balloon was used to postdilate the overlapping zone of the proximal and middle stent. The balloon was inflated at 10 atm. As the balloon was deflated, an Ellis type III perforation was noted ( and ). The same balloon (3.0 × 18 mm) was inflated immediately at the site of perforation.
Ellis type III coronary artery perforation.
The activated clotting time was corrected with 30 mg of intravenous protamine and intravenous tirofiban was immediately stopped. An emergent echocardiogram showed mild pericardial effusion without any evidence of cardiac tamponade and wall motion abnormalities. In the mean time, the patient was asymptomatic and haemodynamically stable. Intermittent balloon inflations continued for the next 30 min but there was still extravasation of dye. We decided to deploy a BMS at the site of perforation as we were unable to locate the covered stent rapidly. The theory was that this may alter the morphology of the vessel and seal the perforation. To this end, a 3.0 × 18 mm driver (Medtronic) BMS was deployed at 8 atm at the site of perforation. This immediately sealed the perforation. The stent was postdilated with a 3.0 × 18 mm stent balloon at 14 atm. The final result was TIMI 3 flow without any extravasation of dye at the site of perforation ().
Sealed coronary artery perforation after bare metal stent (BMS) deployment.