Tratamento de perfuração coronária tipo IV durante intervenção coronária percutânea

Abstract

We report the case of a 61-year-od male, hospitalized for unstable angina. Coronary angiography showed a severe lesion in the middle third of the left anterior descending coronary artery. Percutaneous coronary intervention was performed with stent implantation. Coronary rupture was observed with contrast spilling to the left ventricle (type IV coronary perforation) immediately after balloon post-dilatation. After partial heparin reversal with protamine and prolonged balloon inflation at low pressure, coronary rupture was controlled, with a good final angiographic result. Subsequent echocardiography showed minimal pericardial effusion. Post-procedure clinical follow-up was satisfactory.

Coronary perforation during percutaneous coronary intervention: description of a salvage technique

“…An urgent echocardiography is indicated, with constant followup until the perforation closes. 6,9,11,12 The use of covered stents has shown satisfactory results, with perforation closure in more than 90% of cases. 10 A common problem is that interventional cardiology services do not have this device available, or there is not a device of adequate size for the target vessel, or the device is available, but it is out of date.…”

“…13 To minimize the time of blood extravasation to the pericardium and increase the speed of the device exchange, the puncture of another arterial site, with subsequent catheterization of the same coronary artery, can be used, known as the doubleguide catheter technique, commonly used when there is a need to implant a covered stent. 9,10 In the case reported here, after identifying the perfora tion of the coronary artery, classified as Ellis type II, it was initially decided to occlude the perforation, using prolon ged inflation of a balloon catheter, but without success. It was then decided to occlude the lesion segment by implan ting another stent, using a double guide catheter technique.…”