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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 Seyed Kianoosh Hosseini ORCID 1 , *

1 Farshchian Heart Center, Hamadan University of Medical Sciences, Hamedan, IR Iran

2 Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

How to Cite: Naghshtabrizi B, Mozayanimonfared A, Karimi Akhormeh A, Hosseini S 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 Cardio Res J. 2022;16(2):e126454.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 16 (2); e126454
Published Online: June 15, 2022
Article Type: Case Report
Received: April 03, 2022
Accepted: May 31, 2022
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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 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 noticeable reduction of the pericardial fluid and the
patient was discharged home in favorable conditions. He participated in regular followup
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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© 2022, Shiraz University of Medical Sciences.
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