Coronary Perforation in a Patient with ST Elevation Myocardial Infarction Treated by Stent Graft Implantation Using the Double Guide Catheter (Ping Pong) Technique

authors:

avatar Behshad Naghshtabrizi ORCID 1 , avatar Azadeh Mozayanimonfared ORCID 1 , avatar Ali Karimi Akhormeh ORCID 2 , avatar Kianoosh Hoseini ORCID 1 , *

Farshchian Heart Center, Hamadan University of Medical Sciences, Hamedan, IR Iran
Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
International Cardiovascular Research Journal: Vol.16, issue 2; e126454
published online: June 15, 2022
article type: Case Report
received: April 03, 2022
accepted: May 31, 2022

how to cite: Naghshtabrizi B, Mozayanimonfared A, Karimi Akhormeh A, Hoseini K . Coronary Perforation in a Patient with ST Elevation Myocardial Infarction Treated by Stent Graft Implantation Using the Double Guide Catheter (Ping Pong) Technique. Int Cardiovasc Res J. 2022;16(2):e126454. 

Abstract

Introduction: Coronary perforation can occur as a complication of Percutaneous Coronary Intervention (PCI) even in the contemporary era of new tools and techniques. Severe proximal perforation can potentially be lethal if not diagnosed or left untreated. This dreaded complication can occur due to the mismatch between the balloon and vessel size. However, it may happen with an appropriately sized balloon or stent in case of eccentric coronary calcification or negative vessel remodeling. The current study aimed to present a case of severe type III perforation, which was managed successfully using the double guide catheter technique for stent graft implantation.  
 
Case Presentation: A 61-year-old man with the history of stenting in the Right Coronary Artery (RCA) presented with acute inferior ST Elevation Myocardial Infarction (STEMI). Emergent coronary angiography revealed the acute instent thrombotic occlusion of the RCA. After wiring, predilatation of the previous stent was carried out. Test injection showed Ellis type III coronary perforation. A 3.5*15 mm balloon was inserted promptly and was inflated at the perforation site. Right femoral artery access was obtained and a stent graft was deployed using the double guide catheter or the ping pong technique. The perforation was sealed and extravasation was ceased. Echocardiography showed moderate pericardial effusion without any sign of chamber collapse. Heparin was not reversed in order to prevent stent thrombosis. Further echocardiography 3, 24, and 48 hours after the procedure showed the noticeable reduction of the pericardial fluid and the patient was discharged home in favorable conditions. He participated in regular follow-up visits and did well after about 18 months. 
 
Conclusion: The double guide catheter technique was found to be a safe and effective method in treating Ellis type III coronary perforation. 
 

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