Image in Cardiology
Elective percutaneous coronary intervention complicated by coronary rupture
Intervenção coronária percutânea eletiva complicada por rotura coronária
Carlos Galvão Braga
, Juliana Martins, Carina Arantes, Glória Abreu, João Costa, Jorge Marques
Autor para correspondência
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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"mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1500 "Ancho" => 1500 "Tamanyo" => 101899 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography showing class III perforation (perforation ≥1 mm in diameter with contrast streaming or cavity spilling) after balloon inflation at high pressure. D2: second diagonal branch; LAD: left anterior descending artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary artery rupture is a rare but potentially fatal complication of percutaneous coronary intervention (PCI) that can result in life-threatening cardiac tamponade.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A 69-year-old man was referred for PCI of a 90% calcified lesion in the mid left anterior descending artery (LAD) involving the second diagonal branch (D2; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, arrow). After the left coronary ostium was cannulated and crossed with two BMW<span class="elsevierStyleSup">®</span> wires, one to the LAD and other to the D2, predilation with a 2.5 mm×15 mm Trek<span class="elsevierStyleSup">®</span> balloon was performed and an unsuccessful attempt was made to cross the stenosis with a 2.75 mm×22 mm Resolute Integrity<span class="elsevierStyleSup">®</span> drug-eluting stent. Predilation was repeated with a 2.75 mm×15 mm Trek<span class="elsevierStyleSup">®</span> non-compliant balloon at high pressure. Suddenly, balloon rupture was detected and the angiogram showed LAD rupture with extensive contrast extravasation into the pericardium (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, arrows; Video 1). Protamine sulfate was used to reverse the effect of heparin and the drug-eluting stent was deployed with balloon inflation for 10 minutes to seal the type III perforation but, as dye extravasation persisted, a 3.0 mm×19 mm GraftMaster<span class="elsevierStyleSup">®</span> covered stent was superimposed, followed by rapid cessation of contrast leakage (Video 2). The D2 branch was lost (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>, arrows), and periprocedural myocardial infarction occurred. The final image showed pericardial effusion (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>; Video 3). The echocardiogram excluded tamponade. Forty-eight hours later, atrial fibrillation occurred with hemodynamic deterioration. Pericardiocentesis was performed and 50 ml of serosanguineous fluid was drained. Sinus rhythm was restored, with favorable evolution thereafter.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Treating calcified bifurcated lesions with balloons at high pressure must be performed with caution. If grade III perforation occurs, a standard stent can be used to save the side branch, although this is only successful in a minority of patients.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0010" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-02" "fechaAceptado" => "2014-11-03" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1498 "Ancho" => 1500 "Tamanyo" => 109805 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography demonstrating a 90% calcified lesion (arrows) in the mid left anterior descending artery (LAD) involving the second diagonal branch (D2).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1500 "Ancho" => 1500 "Tamanyo" => 101899 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography showing class III perforation (perforation ≥1 mm in diameter with contrast streaming or cavity spilling) after balloon inflation at high pressure. D2: second diagonal branch; LAD: left anterior descending artery.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1505 "Ancho" => 1500 "Tamanyo" => 115164 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Coronary angiogram after stent graft implantation showing sealing of the LAD rupture area and loss of the second diagonal branch (arrows). LAD: left anterior descending artery.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1500 "Ancho" => 1500 "Tamanyo" => 122239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Final fluoroscopic image showing circumferential pericardial effusion.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1169272 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] 5 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 1259370 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] ] 6 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 547296 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003400000003/v4_201503200652/S0870255115000414/v4_201503200652/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000003/v4_201503200652/S0870255115000414/v4_201503200652/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000414?idApp=UINPBA00004E" ]
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| 2022 Janeiro | 77 | 20 | 97 |
| 2021 Dezembro | 31 | 23 | 54 |
| 2021 Novembro | 44 | 32 | 76 |
| 2021 Outubro | 50 | 40 | 90 |
| 2021 Setembro | 44 | 25 | 69 |
| 2021 Agosto | 33 | 27 | 60 |
| 2021 Julho | 27 | 19 | 46 |
| 2021 Junho | 35 | 19 | 54 |
| 2021 Maio | 31 | 26 | 57 |
| 2021 Abril | 86 | 33 | 119 |
| 2021 Maro | 47 | 28 | 75 |
| 2021 Fevereiro | 64 | 8 | 72 |
| 2021 Janeiro | 45 | 14 | 59 |
| 2020 Dezembro | 25 | 8 | 33 |
| 2020 Novembro | 24 | 6 | 30 |
| 2020 Outubro | 20 | 12 | 32 |
| 2020 Setembro | 68 | 9 | 77 |
| 2020 Agosto | 31 | 5 | 36 |
| 2020 Julho | 52 | 12 | 64 |
| 2020 Junho | 43 | 9 | 52 |
| 2020 Maio | 49 | 3 | 52 |
| 2020 Abril | 47 | 9 | 56 |
| 2020 Maro | 56 | 10 | 66 |
| 2020 Fevereiro | 84 | 34 | 118 |
| 2020 Janeiro | 45 | 12 | 57 |
| 2019 Dezembro | 40 | 13 | 53 |
| 2019 Novembro | 49 | 9 | 58 |
| 2019 Outubro | 42 | 7 | 49 |
| 2019 Setembro | 58 | 7 | 65 |
| 2019 Agosto | 38 | 6 | 44 |
| 2019 Julho | 45 | 7 | 52 |
| 2019 Junho | 52 | 9 | 61 |
| 2019 Maio | 44 | 8 | 52 |
| 2019 Abril | 43 | 24 | 67 |
| 2019 Maro | 52 | 10 | 62 |
| 2019 Fevereiro | 51 | 10 | 61 |
| 2019 Janeiro | 31 | 4 | 35 |
| 2018 Dezembro | 29 | 7 | 36 |
| 2018 Novembro | 91 | 13 | 104 |
| 2018 Outubro | 146 | 11 | 157 |
| 2018 Setembro | 52 | 10 | 62 |
| 2018 Agosto | 40 | 12 | 52 |
| 2018 Julho | 27 | 4 | 31 |
| 2018 Junho | 54 | 10 | 64 |
| 2018 Maio | 59 | 6 | 65 |
| 2018 Abril | 46 | 14 | 60 |
| 2018 Maro | 90 | 11 | 101 |
| 2018 Fevereiro | 52 | 6 | 58 |
| 2018 Janeiro | 27 | 4 | 31 |
| 2017 Dezembro | 75 | 7 | 82 |
| 2017 Novembro | 36 | 9 | 45 |
| 2017 Outubro | 39 | 7 | 46 |
| 2017 Setembro | 39 | 10 | 49 |
| 2017 Agosto | 39 | 19 | 58 |
| 2017 Julho | 36 | 6 | 42 |
| 2017 Junho | 59 | 15 | 74 |
| 2017 Maio | 46 | 14 | 60 |
| 2017 Abril | 33 | 20 | 53 |
| 2017 Maro | 27 | 6 | 33 |
| 2017 Fevereiro | 48 | 7 | 55 |
| 2017 Janeiro | 33 | 4 | 37 |
| 2016 Dezembro | 31 | 6 | 37 |
| 2016 Novembro | 31 | 3 | 34 |
| 2016 Outubro | 43 | 9 | 52 |
| 2016 Setembro | 16 | 7 | 23 |
| 2016 Agosto | 20 | 4 | 24 |
| 2016 Julho | 14 | 3 | 17 |
| 2016 Junho | 16 | 8 | 24 |
| 2016 Maio | 19 | 7 | 26 |
| 2016 Abril | 22 | 4 | 26 |
| 2016 Maro | 54 | 13 | 67 |
| 2016 Fevereiro | 81 | 28 | 109 |
| 2016 Janeiro | 69 | 32 | 101 |
| 2015 Dezembro | 39 | 12 | 51 |
| 2015 Novembro | 47 | 12 | 59 |
| 2015 Outubro | 40 | 19 | 59 |
| 2015 Setembro | 41 | 20 | 61 |
| 2015 Agosto | 44 | 12 | 56 |
| 2015 Julho | 31 | 4 | 35 |
| 2015 Junho | 33 | 4 | 37 |
| 2015 Maio | 61 | 24 | 85 |
| 2015 Abril | 93 | 48 | 141 |
| 2015 Maro | 103 | 66 | 169 |
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