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was observed at the proximal edge of the stent &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Bivalirudin was stopped&#44; prolonged balloon inflation proximal to the perforation was performed and a covered stent &#40;2&#46;5 mm&#215;18 mm&#41; was implanted&#46; The patient suffered tamponade and cardiac arrest which required emergent pericardiocentesis and cardiac resuscitation&#46; After stabilization a new CA showed probable underexpansion of the covered stent &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#44; arrows&#41;&#46; Postdilatation with a non-compliant balloon was performed &#40;3 mm&#215;15 mm&#59; 22 atm&#41;&#44; and intravascular ultrasound &#40;IVUS&#41; confirmed correct expansion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#44; 1&#8211;4&#59; Video 1&#41;&#46; The patient was promptly extubated and discharged&#46; We performed a clinical follow-up&#44; and more than one year later&#44; he remains asymptomatic with no adverse events&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">CAP is a rare &#40;0&#46;43&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> but potentially fatal complication of percutaneous coronary intervention&#46; The most reproducible risk factors are oversizing of devices &#40;balloons or stents&#41;&#44; female gender&#44; advanced age&#44; atheroablative devices&#44; and treatment of complex lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1&#44;2</span></a> Morbidity and mortality vary directly with Ellis classification&#58; tamponade and mortality rates range between 0&#46;4&#37; and 0&#46;3&#37; &#40;Ellis class I&#41; to 45&#46;7&#37; and 21&#46;2&#37; &#40;Ellis class III&#41;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The poor prognosis associated with severe CAP emphasizes the importance of taking measures to prevent this complication&#46; Awareness of risk factors&#44; careful guidewire selection&#44; and avoidance of balloon overexpansion remain the mainstays of CAP prevention&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is no uniform treatment for CAP&#46; A variety of major management strategies&#44; based on little evidence&#44; have been used&#44; including observation&#44; heparin reversal&#44; platelet transfusion&#44; prolonged balloon inflation&#44; covered stent implantation&#44; distal embolization&#44; pericardiocentesis&#44; and surgery&#46;1 Continuous monitoring is essential since deterioration can occur up to 24&#8211;48 hours afterwards&#46; Echocardiography studies should be performed serially&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Polytetrafluoroethylene-covered stents prevent blood leakage between stent struts&#44; and a high rate of success has been reported&#46; However&#44; they have some limitations&#58; they lack elasticity and rapid and correct deployment in calcified arteries&#44; in which the majority of perforations occur&#44; can be difficult&#46;1 In addition&#44; higher rates of stent restenosis and thrombosis have been described compared with bare-metal stents and drug-eluting stents&#44; and they also have higher rates of adverse events in long-term follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">After stabilizing the patient&#44; we should not rush&#44; because&#44; in cases like ours&#44; intracoronary imaging techniques such as IVUS may be useful to ensure correct expansion and reduce further adverse events&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Coronary artery perforation"
            1 => "Covered stents"
            2 => "Intravascular ultrasound"
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            0 => "Perfura&#231;&#227;o da art&#233;ria coron&#225;ria"
            1 => "<span class="elsevierStyleItalic">Stents</span> revestidos"
            2 => "Ultrassonografia intravenosa"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary artery perforation &#40;CAP&#41; is a rare but potentially fatal complication of percutaneous coronary intervention&#46; Polytetrafluoroethylene-covered stents prevent blood leakage between struts with a high rate of success&#46; However&#44; they lack elasticity and rapid and correct deployment is difficult&#46; They have also a higher rate of stent restenosis and thrombosis&#46; For these reasons&#44; optimal deployment is essential&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Although severe CAP needs an emergent solution&#44; after stabilizing the patient&#44; intracoronary imaging techniques may be useful to ensure correct expansion and reduce further adverse events&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We present a case that shows the potential role of intravascular ultrasound in the resolution of a CAP&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A perfura&#231;&#227;o da art&#233;ria coron&#225;ria &#40;PAC&#41; &#233; uma complica&#231;&#227;o rara&#44; mas potencialmente fatal da interven&#231;&#227;o coron&#225;ria percut&#226;nea &#40;ICP&#41;&#46; Os <span class="elsevierStyleItalic">stents</span> revestidos com politetrafluoroetileno impedem o <span class="elsevierStyleItalic">leakage</span> do sangue entre os suportes com uma elevada taxa de sucesso&#46; No entanto&#44; a falta de elasticidade e o posicionamento r&#225;pido e correto s&#227;o dif&#237;ceis&#46; Apresentam tamb&#233;m uma taxa mais elevada de reestenose de <span class="elsevierStyleItalic">stent</span> e de trombose&#46; Por este motivo&#44; &#233; fundamental um posicionamento otimizado&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Embora a PAC necessite de uma solu&#231;&#227;o emergente&#44; ap&#243;s estabilizar o doente&#44; as t&#233;cnicas intracoron&#225;rias imageol&#243;gicas podem ser &#250;teis para assegurar a expans&#227;o correta e reduzir eventos adversos adicionais&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Apresentamos um caso que revela o papel potencial da ultrassonografia intravenosa na resolu&#231;&#227;o de uma PAC&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Coronary angiography &#40;right anterior oblique view&#41; showing a severe lesion in the mid left anterior descending artery &#40;arrow&#41;&#59; &#40;B&#41; underexpanded biolimus-eluting stent &#40;arrow&#41;&#59; &#40;C&#41; coronary artery perforation after postdilation with non-compliant balloon&#59; &#40;D&#41; coronary angiography after hemodynamic stabilization showing probable underexpansion of the covered stent &#40;arrows&#41;&#59; &#40;D1&#8211;4&#41; intravascular ultrasound after postdilation with non-compliant balloon&#58; &#40;D1&#41; segment with a well-expanded covered stent and hematoma outside the lumen&#59; &#40;D2 and 3&#41; segment with two layers of stent &#40;covered stent and biolimus-eluting stent&#41;&#59; &#40;D4&#41; segment with a biolimus-eluting stent only&#46;</p>"
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