Coronary artery rupture in hybrid treatment

#CardioTwitterCase originally published on Twitter

This case was originally published on Twitter by @paulgamboad

Clinical presentation

A 69-year-old male patient underwent surgical procedures for aortic valve replacement and hybrid myocardial revascularization, including the placement of an internal mammary artery graft to the left anterior descending artery.

During the angioplasty of the right coronary artery, an artery rupture occurred, which was resolved by prolonged inflation of a coronary balloon.

Case description

We present the case of a 69-year-old male patient who was diagnosed with severe aortic stenosis and three-vessel coronary artery disease. Due to poor distal beds in the right coronary artery and left circumflex artery, a hybrid approach was chosen. The patient underwent surgical aortic valve replacement and received an internal mammary artery graft to the anterior descending artery. Subsequently, coronary angioplasty was performed on the posterior descending branch of the right coronary artery and the left circumflex artery.

During the angioplasty, a non-dilatable lesion was observed in the posterior descending branch of the right coronary artery. A Telescope® Medtronic guide catheter extension was used, followed by non-compliant balloon dilations of 2.0 x 20 mm, 2.25 x 15 mm, and 2.5 x 15 mm. The plaque was successfully dilated but resulted in artery perforation (video 1), leading to contrast medium extravasation.

To address this, a prolonged inflation with a 2.5 x 15 mm balloon for 4 minutes was performed, effectively controlling the bleeding (video 2). Subsequently, a drug-eluting stent of 2.25 x 20 mm (Boston Scientific® Marlborough, MA) was implanted (video 3).

The patient had a satisfactory recovery without complications and was discharged after 3 days.

Videos

Final remarks

In conclusion, prolonged balloon inflation is a valuable tool in managing coronary artery ruptures during coronary angioplasty.

Author

Paul Gamboa

@paulgamboad

Interventional cardiologist / Cardiologist

Bogotá, Colombia

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