28: Coronary Perforation Caused by a Guidewire

CASE 28 Coronary Perforation Caused by a Guidewire





Cardiac catheterization


In an effort to avoid closure of the diagonal side branch, the operator chose a “crush stent” technique to treat the left anterior descending artery and diagonal branch. Using an 8 French, left Judkins 4.0 guide catheter and procedural anticoagulation consisting of unfractionated heparin (5300 units) and eptifibatide (two boluses of 15.8 mg followed by an infusion of 2 mcg/kg/min), the operator positioned a floppy-tipped 0.014 inch guidewire into both the left anterior descending artery and diagonal branch and predilated the stenosis in the left anterior descending artery with a 2.5 mm diameter by 15 mm long compliant balloon, resulting in further compromise of the lumen of the diagonal artery (Figures 28-2, 28-3 and Video 28-2). Balloon dilation of the diagonal was performed, and during the catheter manipulations, the operator noted that the tip of the diagonal wire appeared to have migrated either into a small branch or outside of the lumen of the diagonal artery (Figure 28-4). The wire was repositioned and angiography demonstrated contrast staining emanating from the diagonal branch consistent with a wire perforation (Figure 28-5 and Video 28-3). The patient remained asymptomatic and hemodynamically stable with no evidence of tamponade. The operator continued the eptifibatide infusion after repeat angiography 5 minutes later showed persistent contrast staining but no evidence of active bleeding from the site. The “crush stent” procedure was performed with a 3.0 mm diameter by 18 mm long sirolimus-eluting stent placed in the left anterior descending artery and a 2.25 mm diameter by 12 mm long bare-metal stent placed in the diagonal branch (Figure 28-6). The final angiographic appearance was excellent with no evidence of additional contrast extravasation from the wire perforation site (Figure 28-7 and Video 28-4). The obtuse marginal lesion was then treated with another drug-eluting stent without complication.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jun 11, 2016 | Posted by in CARDIOLOGY | Comments Off on 28: Coronary Perforation Caused by a Guidewire

Full access? Get Clinical Tree

Get Clinical Tree app for offline access