title: Guidewire-induced coronary perforation successfully treated with subcutaneous fat embolisation: A simple technique available to all.
abstract: A 62-year-old man presented with an anterior ST elevation myocardial infarction and underwent primary percutaneous coronary intervention to an occluded diagonal artery. Following stenting, a type III distal guidewire-induced coronary perforation of the diagonal branch was recognized with extravasation of contrast into the pericardial space. Prolonged balloon inflations proximal to the site of the perforation were unsuccessful. Subcutaneous fat was therefore harvested from the patients upper thigh under local anesthetic and embolized through an Export catheter into the distal diagonal vessel, resulting in the immediate cessation of leak through the site of perforation. We discuss the technical aspects of this technique as well as alternative methods of distal embolization and the potential complications that must be considered.
authors.affiliation: Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: George
authors.affiliation: Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cotton
authors.affiliation: Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Wrigley
mesh_terms: D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D064592:Autografts; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D004621:Embolization, Therapeutic / Q000379:methods*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D050151:Subcutaneous Fat / Q000637:transplantation*; D013848:Thigh; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: angioplasty; complication; pericardial effusion