DefinePK

Research Objective

To describe a unique case of coronary perforation management using a man-made covered stent and an un-inflated semi-compliant balloon over a standard Drug Eluting Stent (DES).

Methodology

Case report detailing the management of coronary artery perforation during Percutaneous Coronary Intervention (PCI). A novel technique involved creating a "man-made" covered stent by using a semi-compliant balloon and a standard Drug Eluting Stent (DES).

Methodology Flowchart

                        graph TD
    A["Patient presents with angina/dyspnea"] --> B["Coronary Angiogram"];
    B --> C["Coronary Perforation Identified"];
    C --> D["Initial Management: Balloon Tamponade"];
    D -- Unsuccessful --> E["Assess Need for Covered Stent"];
    E -- Appropriate Size Unavailable --> F["Create Man-Made Covered Stent"];
    F --> G["Deploy Man-Made Covered Stent"];
    G --> H["Assess Perforation Sealing"];
    H -- 100% Sealed --> I["Post-procedural Observation"];
    I --> J["Patient Discharge"];                    

Discussion

Coronary artery perforation is a serious complication of PCI, with increased mortality risk. While standard management includes covered stents, coil embolization, or CABG surgery, this case highlights the utility of a handmade covered stent as a quick, easy, and affordable alternative when appropriate-sized covered stents are unavailable.

Key Findings

A 73-year-old male patient experienced an Ellis type-II coronary perforation during PCI of the Obtuse Marginal (OM) branch. After prolonged balloon tamponade failed, a man-made covered stent was successfully deployed, resulting in 100% sealing of the perforation and TIMI III flow in the artery. The patient was discharged uneventfully after 3 days.

Conclusion

Early recognition and prompt management of coronary artery perforation are crucial. Handmade covered stents can be life-saving in situations where standard covered stents are not readily available, offering a practical solution for complex PCI procedures.

Fact Check

1. Patient Age: The patient was 73 years old. (Confirmed in Case Presentation)
2. Perforation Type: The perforation was identified as Ellis type-II. (Confirmed in Case Presentation)
3. Discharge Time: The patient was discharged after 3 days. (Confirmed in Case Presentation)

Mind Map