Emergency management - Type V: Distal segment

Perforation of the distal segment

Type V coronary perforation takes a look at perforation of the distal segment due to coronary guidewire tip exiting the coronary artery distally.


Management algorithm

Type V coronary artery perforations may be initially missed as the leak into the pericardium is often small and may requiring panning to the distal vessel to be appreciated. Management may require embolisation of the distal vessel with thrombin, coils or fat. Beware of collateral flow to the affected territory which can cause the perforation to persist despite apparently successful embolisation.

Coronary perforation Type V algorithm

Additional links

Link 1 - Inflate balloon at perforation site

Link 4 - Thrombin injection

Link 5 - Coil embolisation

Link 6 - Autologous subcutaneous fat embolisation

Case library

Consult the 1st Case study: distal perforation coils

Consult the 2nd Case study: reverse heparin

Consult the 3rd Case study: thrombin injection


This case report does not reflect the opinion of PCR or PCRonline, nor does it engage their responsibility.