Published online Jun 26, 2021. doi: 10.4330/wjc.v13.i6.177
Peer-review started: December 9, 2020
First decision: February 28, 2021
Revised: March 8, 2021
Accepted: March 31, 2021
Article in press: March 31, 2021
Published online: June 26, 2021
Processing time: 194 Days and 20.6 Hours
Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with embolization of coils, fat, thrombin, or collagen. We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation. we advocate this method as a simple method of managing distal vessel perforation.
A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex. At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation. A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.
The use of a balloon remnant for embolization in coronary perforation presents a simple, efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome. Prevention remains the most important part with meticulous attention to the distal wire position, particularly with hydrophilic wires.
Core Tip: The use of a remnant balloon for sealing a coronary perforation can be a cost-effective method of treating this complication using a readily available material. In cases where the sealing of the perforation is indicated, a careful and controlled approach for delivering the balloon remnant will ensure the safe and effective delivery and the sealing of the perforation which in turn will help stabilize and safe the patient by controlling any further bleeding.