A coronary artery perforation during percutaneous coronary intervention is an uncommon (0.43%) but potentially severe event, with high risk of cardiac tamponade and death. Severe perforations require placing a covered stent, which is often unavailable. We describe an alternative and simple treatment technique, which can be performed using polytetrafluoroethylene from a balloon tied over a coronary stent.

Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.

Background The transradial access has gained great prominence in interventional coronary procedures due to lower complication rates, especially when the radial artery is punctured distally, in the anatomical snuffbox. The objective of this study was to analyze the complication and crossover rates of the access routes in invasive coronary procedures, comparing the distal radial artery to the proximal transradial route in the styloid process and the transfemoral access. Methods This was a prospective, observational, and single-center cohort study. The results of access routes were compared, using the primary outcomes of puncture site-related complications and initial arterial access crossover. Results A total of 748 patients were included; in that, 152 (20.3%) in the Distal Transradial Access Group, 388 (51.9%) in the Proximal Transradial Access Group, and 208 (27.8%) in the Transfemoral Access Group. No complications were observed in the Distal Transradial Access Group, whereas two patients (0.5%) had mild local hematomas in the Proximal Transradial Access Group, and six participants (2.9%) had complications in the Transfemoral Access Group, with mild local hematomas in four patients (1.9%), a pseudoaneurysm in one (0.5%), and an active bleeding in one (0.5%) – all with no need for surgical intervention (p=0.01). The crossover rate was 9.2% in the Distal Transradial Access Group, 5.9% in the Proximal Transradial Access Group, and 0.9% in the Transfemoral Access Group (p=0.001). Conclusion The distal radial artery access had a lower rate of vascular/hemorrhagic complications when compared to the proximal transradial access in the styloid process and the transfemoral access. However, the crossover rate was higher when the distal radial artery access was the operator’s first choice.