Type 3 Coronary Perforation on Optical Coherence Imaging

J INVASIVE CARDIOL 2019;31(11):E337-E338.

Key words: cardiac imaging, Dragonfly imaging catheter, optical coherence tomography

A 64-year-old male with acute anterior wall myocardial infarction was taken up for primary angioplasty and a 3 x 33 mm Xience stent (Abbott Vascular) was deployed at 14 atm. Postdilation at the site of under-expansion with a 3.5 x 12 mm non-compliant (NC) balloon at 20 atm resulted in a type 3 perforation of the mid left anterior descending coronary artery.

A 3.5 x 15 mm NC balloon was kept inflated at 10 atm for 10 minutes, and anticoagulation was reversed. Check angiogram revealed temporary cessation of contrast extravasation. Optical coherence tomography (OCT) imaging with a Dragonfly catheter (St. Jude Medical) revealed a 1.5 mm-long transmural breach in a segment of the artery devoid of calcium or eccentric plaque burden. Focal negative remodeling identified on OCT was deemed the reason for the otherwise unexplained cause of the coronary rupture (Figures 1a-1i and Video 1). 

There was recurrence of contrast extravasation on coronary angiogram with hemodynamic instability, necessitating placement of a 3.5 x 30 mm Prograft covered stent (Vascular Concepts) deployed at 14 atm, sealing the perforation (Figures 1j-1o and  Video 2).

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From the Department of Cardiology, Christian Medical College and Hospital, Vellore, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted February 13, 2019.

Address for correspondence: Dr Viji Samuel Thomson, Dept. of Cardiology, Christian Medical College and Hospital, Vellore, India 632 004. Email: vijisamuel1970@gmail.com