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From the Start to the End-using Proximal Right Coronary Artery Thrombus to seal a Distal Right Coronary Artery Guide-Wire Induced Perforation

Boon Wah Matthew Liew, Svenszeat Tan and Colin Yeo

Coronary artery perforation is a rare but feared complication in percutaneous coronary artery intervention. Various techniques and methods have been proposed in the management of a coronary artery guide-wire induced perforation. We present a unique case of using the thrombi aspirated from a proximal right coronary artery occlusion to seal the distal branch perforation induced by the coronary guide wire. The patient had presented with an acute coronary syndrome requiring urgent percutaneous coronary intervention. Unfortunately he developed a distal artery perforation which was did not seal despite multiple prolonged balloon inflations. In the absence of available adjunctive device such as coronary coils or gel foam, we had improvised using thrombi aspirated from the proximal occlusion to seal the distal small branch perforation with success. There was no significant pericardial effusion post-procedure and the patient recovered uneventfully. A check coronary angiography done during the staged percutaneous coronary intervention of his left anterior descending artery showed preserved flow in the distal right coronary artery. This case highlighted the successful improvised treatment of a coronary guide-wire induced perforation using thrombus injection.