Percutaneous coronary intervention (PCI) as a treatment of coronary artery disease can be a simple, rapid procedure with a clear benefit for the patient, but it could also become a complex procedure with fatal consequences. These complications depend on the lesion itself, material used and also on operating staff. In this case we report a coronary artery rupture of the circumflex intermediate (CX-IM) artery caused by inflation of an oversized balloon.
A 50 years old man patient admitted to chest pain(most often occurs with activity) and hospitalization for coronary angiography. Percutaneous transluminal coronary angioplasty and stenting of Cx-Im artery was planned because of significant distal lesion. Successful Cx-Im stenting(2.50 X 20 mm; 12 atm,Promus, Boston Scientific,USA) was performed. The stent appeared relatively underexpanded iterative inflation of 2.5 X 20 mm noncompliant balon at 16 atm was performed and resulted in complete expansion of stent. The patient described a mild sharp and stabbing chest pain. Angiography after the last inflation revealed a large coronary artery wall perforation at the stent location with distal TIMI 3 flow(figure 1). Patient hemodiynamics was fastly deteriorated and went into shock due to cardiac tamponade. We performed pericardiocentesis in the coronary angiography lab and successfully sealing with graft stenting( 2.5 X 20 mm). Finally angiogram showed that distal TIMI 3 flow without pericardial bleeding.
