Repair of Coronary Artery Perforation Into the Left Ventricle Using Graftmaster Stent Graft After Complicated Percutaneous Coronary Intervention of Myocardial Bridge

Abstract

A myocardial bridge (MB) is a band of heart muscle that lies on the top of a coronary artery, instead of underneath it. This leads to tunneling of coronary artery through this segment of the myocardium which can be mechanically compressed during systole, also known as myocardial bridging. Although usually asymptomatic, it can be associated with exertional angina, acute coronary syndrome, cardiac arrhythmia or even sudden cardiac death. The utilization of percutaneous coronary intervention (PCI) of the bridged segment to ameliorate vessel compression and normalize blood flow is limited due to concerns of complications, particularly restenosis and perforation. Although conventional management of coronary perforation includes prolonged balloon dilation and reversal of anticoagulation, stent grafting of these perforations is not uncommonly utilized. We report a case of a patient with symptomatic MB who underwent a PCI of the bridging segment of the left anterior descending (LAD) coronary arterywhich was complicated with a perforation into the left ventricle. As patient became symptomatic, the perforation was emergently repaired using a Graftmaster ® RX coronary stent graft system (Abbott Vascular) with complete alleviation of symptoms and successful radiographic resolution.