PMC7251425_01
Coronary angiography of the patient. (a) CTO of RCA. (b, c) Collaterals from LAD to RCA territory. Retrograde filling of RCA. (d) LAD/D1 bifurcation lesion.
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A new invasive coronary angiography (ICA) showed no significant changes in comparison with previous findings (Figure 1).
Ellis type III RCA perforation.
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III perforation of the vessel was caused (Figure 2), as the balloon predilatation was found to have been implemented in an acute marginal branch that ran parallel to the main vessel. Inflating a balloon proximally to the perforation was intended to stop further blood extravasation.
(a) Extravasation causing cardiac tamponade. (b) Urgent pericardiocentesis under fluoroscopic guidance.
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Urgent pericardiocentesis under fluoroscopic guidance (Figure 3) fortunately stabilized the patient.
Final angiographic results. (a) CTO PCI of RCA; (b) PCI of LAD/D1 bifurcation lesion.
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The final angiographic result of the CTO PCI of the RCA was very good (TIMI flow grade 3) (Figure 4), and the patient was transferred to the coronary care unit being hemodynamically stable and asymptomatic. An excellent angiographic result was finally succeeded (Figure 4), and 3 days later, the patient was discharged being asymptomatic.