PMC3927117_01
A significant stenosis is seen between the markers of the bare metal stent in the mid segment of the LAD (left anterior descending) artery
PWKI-9-21741-g001.jpg
PMC3927117_01_PWKI-9-21741-g001.jpg
F0001
Due to plaque shift and residual stenosis at the distal part of the first stent, a second 2.75 mm x 18 mm Nobori (Terumo Japan) drug-eluting stent was implanted at 18 atm overlapping the proximal one (Figure 1).
The fully expanded 3.5 mm x 20 mm Sprinter balloon at 20 atm shows a small amount of bulging in the mid portion
PWKI-9-21741-g002.jpg
PMC3927117_01_PWKI-9-21741-g002.jpg
F0002
Sprinter balloon was inflated at 18 and then 20 atm. Since the result was not satisfactory, a 3.5 mm x 16 mm Sprinter balloon was once more inflated at 20 atm (Figure 2).
Ellis type 3 coronary perforation is seen
PWKI-9-21741-g003.jpg
PMC3927117_01_PWKI-9-21741-g003.jpg
F0003
Further injection revealed Ellis type 3 perforation of the vessel from just beneath the overlapped region (Figure 3).
After first bare metal stent implantation following prolonged balloon inflation diminished but ongoing leakage is seen
PWKI-9-21741-g004.jpg
PMC3927117_01_PWKI-9-21741-g004.jpg
F0004
A 3.0 mm x 16 mm Liberte BMS was implanted at 16 atm which diminished the leakage (Figure 4).
After second bare metal stent implantation, there is no more contrast extravasation into the pericardial space. This is evaluated as complete sealing of the coronary perforation
PWKI-9-21741-g005.jpg
PMC3927117_01_PWKI-9-21741-g005.jpg
F0005
Control angiography showed no extravasation (Figure 5).
LAD is seen as normal 10 days after the sealed coronary perforation
PWKI-9-21741-g006.jpg
PMC3927117_01_PWKI-9-21741-g006.jpg
F0006
Ten days later the RCA was stented from a left radial approach and the LAD was found to be intact (Figure 6).