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￭♣ S-217 ￭
저자 요청 취소
￭ S-218 ￭
Left Venticular Spilling Coronary Perforation during Percutaneous Coronary Intervention
성가롤로병원
*이윤호, 김미양, 김수현
Introduction: Coronary perforation is a rare but possibly fatal complication of percutaneous coronary intervention (PCI). We report a case of coronary perfotration during PCI that spilled into left ventricular cavity, which was successfully managed with covered stent. Case Description: A 66-year-old woman presented with chest pain. Coronary angiography showed total occlusion in proximal left anterior descending artery (p-LAD). (Fig.1) After cor- onary angioplasty using 2.0×20 mm balloon was done, (Fig.2) residual stenosis was seen (Fig.3). And intravascular ultrasound showed large amount of mixed plaque. (Fig.4) So 3.0×32 mm stent for mid-LAD was deployed. (Fig.5) Immediately after stenting, angiogram revealed coronary artery perfo- ration in the mid-portion of stent with extravasation into left ventricular cavity. (Fig.6) At that moment cardiac arrest occured and 2.8×19 mm graft stent was deployed with concurrent cardiopulmonary resuscitation. (Fig.7) After spontaneous circulation returned, we deployed 3.5×32 mm stent for p-LAD.
(Fig.8) 3 days later echocardiography showed only minimal pericardial effusion. (Fig.9,10) Discussion: Coronary perforation often result in refractory cardiac tamponade that require pericardiocentesis. And it is more common in Ellis class III than other classes. In this case almost all extravasated blood spilled into left ventiruclar cavity without external ventricular spillage. Certainly this uncommon features, in addition to early detection and proper man- agement, contributed to favorable clinical outcome.
