Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1937-1945
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1937
Life-threatening subclavian artery bleeding following percutaneous coronary intervention with stent implantation: A case report and review of literature
Fei Shi, Ying Zhang, Li-Xian Sun, Sen Long
Fei Shi, Ying Zhang, Li-Xian Sun, Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Sen Long, Traditional Chinese Medicine, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Author contributions: Shi F managed the case and edited the manuscript; Zhang Y assisted with editing and revising the manuscript; Sun LX and Long S read and approved the final manuscript.
Supported by Scientific Research Program of Hebei Administration of Traditional Chinese Medicine, China, No. 2021201; and Science and Technology Support Plan Project of Chengde, China, No. 201701A072.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Zhang, MD, Chief Doctor, Department of Cardiology, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China. cyfyzy@aliyun.com
Received: August 4, 2021
Peer-review started: August 4, 2021
First decision: October 16, 2021
Revised: October 26, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: February 26, 2022
Processing time: 203 Days and 10 Hours
Abstract
BACKGROUND

Vascular complications of transradial percutaneous coronary intervention (PCI) are rare and usually occur at the access site below the elbow. Life-threatening vascular complications during transradial PCI therapy, such as vessel perforation and dissection in the brachiocephalic, subclavian, internal mammary, and thyrocervical arteries, are rarely reported. Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly.

CASE SUMMARY

A male patient with typical angina pectoris underwent coronary angiography and stent implantation. During the procedure, the patient felt pharyngeal pain and tightness, which we mistook for myocardial ischemia. After PCI, swelling in the right neck and supraclavicular area was observed. The patient experienced dyspnea, emergency endotracheal intubation was performed, and then a sudden drop in blood pressure was observed. Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding. Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery. A covered stent was deployed to the right subclavian artery with successful sealing of the perforation, and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.

CONCLUSION

Subclavian artery bleeding is a lifethreatening complication of PCI. Early prevention, rapid recognition, and prompt treatment may improve the prognosis.

Keywords: Bleeding; Complication; Percutaneous coronary intervention; Subclavian artery; Stent; Case report

Core Tip: Subclavian artery bleeding is a rare and serious complication of transradial percutaneous coronary intervention leading to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly. Bleeding at the root of the subclavian artery might manifest as pharyngeal pain and cervical hematoma, which requires the prompt decision to perform emergency endotracheal intubation. Computed tomography scans should be performed as early as possible for patients with suspected hematoma. Endovascular treatment with covered stents appears to be less time consuming and more effective, especially for large, life-threatening perforations, with great success rates and immediate control of bleeding.