Case study 02 Type III: banner

Case study: a calcified LAD Type III perforation

Complications - Coronary perforation

Consult this case study on a calcified LAD Type III perforation, male 79-year old patient.

Predictors

  • Age
  • Chronic hypertension
  • Calcified lesion
  • Over-sized non-compliant balloon (balloon-to-artery ratio >1.2)

Strategy

  • Immediate balloon tamponade
  • Double guiding catheters technique
  • 2nd generation covered-stent (good crossability) - consult Link 3
  • Urgent reversal of anticoagulation not necessary
  • Immediate and early echocardiogram

For further reading, please consult Link 3 - Choice of covered stent

Tips and Tricks

  • Careful study of lesion anatomy and avoid over-sized balloon/device (keep balloon-to-artery ratio at 1.0)
  • Keep deflated balloon within lesion or guiding catheter for immediate balloon tamponade if unexpected perforation occurs
  • Liberal use of 2nd generation covered-stent
  • Double guiding catheters technique

For further reading, please consult the Double guiding catheters technique

Disclaimer

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