title: Sealing of a dual feeding coronary artery perforation with homemade spring guidewire.
abstract: Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but potentially life-threatening complication. The source of the bleeding is usually from one of the coronary arteries. In the era of chronic total occlusion technique, retrograde approach strategy sometimes is performed using collateral channels. When CAP occurs distal from the collateral channel, the source of bleeding can be from dual arteries, i.e., main and contra-lateral artery. Therefore, management of this bleeding should be intended to close the channel from both the arteries. We have successfully performed an emergent microcoil embolization in a patient with uncontrolled Ellis grade III perforation resulting cardiac tamponade which need pericardiocentesis. The perforation was sealed with the use of cutting the distal part of spring guidewire deployed at the septal collateral channel and fibered microcoil embolization deployed at the distal part of the other vessel. During 1 month follow-up, the patient was found to be well. In conclusion, CAP may result from two source of bleeding and should be kept into consideration. We successfully stopped the bleeding using the combination of fibered microcoil and tip of the spring guidewire.
authors.affiliation: Binawaluya Cardiac Center, Jakarta, Indonesia.
authors.forename: Beny
authors.initials: B
authors.lastname: Hartono
authors.affiliation: Binawaluya Cardiac Center, Jakarta, Indonesia.
authors.forename: Sasmojo
authors.initials: S
authors.lastname: Widito
authors.affiliation: Binawaluya Cardiac Center, Jakarta, Indonesia. muna@cbn.net.id.|Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. muna@cbn.net.id.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Munawar
mesh_terms: D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D020519:Pericardiocentesis / Q000379:methods*; D011183:Postoperative Complications; D057772:Vascular System Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Cardiac tamponade; Coronary artery perforation; Homemade coil