title: Covered stent implantation through a single 8-french guide catheter for the management of a distal coronary perforation.
abstract: Distal coronary perforation can cause early or late tamponade and is usually treated with fat or coil embolization. An alternative treatment strategy is occlusion of the ostium of the perforated vessel via implantation of a covered stent in the main vessel, which is typically achieved using the ping-pong guide catheter technique. In this technique, a balloon is inflated over one guide catheter to stop pericardial bleeding and a covered stent is delivered through a second guide catheter due to inability to fit both a balloon and a covered stent through a single guide catheter. With development of lower profile rapid exchange covered stents, a single guide catheter can be used to both occlude the target vessel and deliver the covered stent. We describe a case of distal vessel perforation in which a balloon was inflated to stop pericardial bleeding, followed by delivery of a covered stent (Graftmaster, Abbott Vascular) through a single 8-Fr guide catheter. This "block and deliver" technique represents a novel paradigm for treating coronary perforations through a single guide catheter, obviating the need for the ping-pong guide catheter technique. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota.|Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Yader
authors.identifier: http://orcid.org/0000-0003-4800-2972
authors.initials: Y
authors.lastname: Sandoval
authors.affiliation: Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Angie S
authors.initials: AS
authors.lastname: Lobo
authors.affiliation: Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Emmanouil S
authors.identifier: http://orcid.org/0000-0001-9416-9701
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
keywords: complications; percutaneous coronary intervention; perforation