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PCI Complication - Coronary Perforation — EECC MCQ

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HardCoronary Artery DiseasePCI Complication - Coronary PerforationEECC

A 55-year-old man undergoes PCI to a heavily calcified proximal LAD lesion. During stent deployment, the operator notes contrast extravasation beyond the vessel wall on fluoroscopy. The patient develops sudden hypotension and tachycardia. What is the most appropriate immediate action?

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Correct answer: C — Inflate a balloon at the perforation site and arrange emergency pericardiocentesis

Coronary perforation (Ellis classification) with contrast extravasation into the pericardial space and haemodynamic compromise indicates a type III perforation, which is a life-threatening emergency. The immediate management is prolonged balloon inflation at the perforation site to achieve tamponade of the leak, while simultaneously arranging emergency pericardiocentesis for the developing cardiac tamponade. A covered stent (PTFE-covered) may be deployed subsequently to seal the perforation. Protamine may be considered but balloon tamponade and drainage take priority. Emergency surgery is the fallback if percutaneous measures fail.

Reference: BCIS/BSC Guidelines on Management of Coronary Perforation