Left Main Coronary Artery Perforation Treated with Conventional Stent (A Real Management Dilemma)

Abstract

Background: Left main coronary artery (LMCA) perforation is a very rare complication of percutaneous coronary intervention (PCI); there is a scarcity of data for its treatment and almost a lack of literature for the use of regular coronary stent for its management.

Case Presentation: We report a case of 90 years old male who presented with anterior wall myocardial infarction (AWMI) and developed Ellis Type 3 coronary artery perforation in calcified LMCA. Post dilatation of ostial Left anterior descending artery (LAD) stent was successfully managed with the deployment of regular drug-eluting stent (DES), preceded by immediate balloon tamponade.

Management & Results: The patient remained hemodynamically stable, and his echocardiogram did not show pericardial effusion or tamponade and was discharged home eventually in a stable condition.

Conclusion: In conclusion, LMCA perforation may occur during high-pressure post dilatation of calcified artery as evident from earlier studies but can be managed successfully with conventional coronary artery stent placement, provided there will be no hemodynamic compromise or tamponade. This case report has introduced a new concept of managing coronary artery perforation, which may reduce the risk of in-stent restenosis significantly associated with using a covered stent.