Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Abstract

ABBREVIATIONS PCI-percutaneous coronary interventionPTFE-polytetrafluoroethylene NSTEMI-non ST segment elevation myocardial infarction LVH-left ventricular hypertrophy LAD-left anterior descending artery D1-first diagonal branch S1-first septal branch RCA-right coronary artery SC-semi compliant balloon DES-drug eluting stent BMS-bare metal stent CPR-cardiopulmonary resuscitation CABG-coronary artery bypass graft CASE REPORTA 68 year old female was admitted to the cath lab due to complaints of postinfarction angina. She suffered an anterior NSTEMI 5 months prior to presentation. Her risk factors for cardiovascular disease were as follows: hypertension, diabetes, dyslipidemia, and a history of smoking. An electrocardiogram showed sinus rhythm, with a rate of 75 bpm, as well as signs of LVH and a reduced R in V2. Echocardiography revealed a reduced ejection fraction -40% and anterior wall hypokinesia. Angiography was performed, showing that the LAD was diffusely atherosclerotic and calcified, with tight stenosis approaching 90% of the vessel lumen immediately after the D1 and S1 branches (Figure1).