Rare complication of primary percutaneous coronary intervention - perforation of the axillary artery

Abstract

Introduction Several arteries can be used as the approach for coronarography or primary percutaneous coronary intervention (pPCI). In patients with acute ST-elevation myocardial infarction (STEMI), when performing pPCI according to the current recommendations, approach artery should be the radial artery. Complications of the transradial approach, such as spasm, asymptomatic occlusion, perforation, nerve damage, arteriovenous fistula, compartment syndrome, and radial artery pseudoaneurysm are described. However, only a few cases describe rare complications of transradial approach such as the perforation of the axillary artery. Case outline The patient was admitted due to the STEMI. Urgent coronarography found 90% stenosis of the proximal segment of the left anterior descendent branch of the left coronary artery (LAD). During the pPCI, a metal stent was implanted in the proximal segment of the LAD. One hour after the intervention, a hematoma in the right arm was registered with the hemodynamic collapse. Angiography of the left axillary artery showed an extravasation of the contrast. A graft stent was implanted in the area of extravasation. After the intervention, regression of the hematoma was registered. Ten years after the primary intervention, CT coronarography and angiography were performed. The stent in the LAD, as well as in the axillary artery, was without any stenosis. Conclusion Advanced life expectancy, hypertension, atherosclerosis, anatomical variations, and blood vessel tortuosity contribute to the perforation of the axillary artery, a very rare complication of the radial approach. It is usually treated conservatively. In the case of hemodynamic instability, a stent implantation can be considered, as it was in our case.