Affiliations

Advocate Lutheran General Hospital, Advocate Illinois Masonic Medical Center

Presentation Notes

Poster presented at: American College of Cardiology Middle East Conference; Dubai, United Arab Emirates

Abstract

Background: Coronary artery perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Standard management includes balloon tamponade, coil embolization, or covered stent placement. Case: A 61-year-old male with diabetes, hypertension, and hyperlipidemia presented with anterior ST-elevation myocardial infarction (STEMI). Angiography showed 100% occlusion of the proximal left anterior descending (LAD) artery. After drug-eluting stent (DES) placement, plaque shift led to first diagonal branch occlusion. Balloon angioplasty caused vessel perforation and tamponade, confirmed by transthoracic echocardiogram (TTE). Emergent pericardiocentesis was performed with autotransfusion. Coil embolization failed due to catheter limitations. Discussion: Autologous fat embolization was performed by harvesting pericardial fat and injecting it into the perforated vessel, achieving temporary hemostasis. Recurrent bleeding necessitated return to the lab, where a covered stent was deployed. The patient was stabilized and discharged on indefinite dual antiplatelet therapy (DAPT). Conclusion: Autologous fat embolization may serve as a novel, life-saving temporizing option for coronary perforation when conventional strategies are unsuccessful.

Type

Poster

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