Stent-graft and double-guiding catheter technique to rescue iatrogenic coronary perforation

INTRODUCTION: Coronary artery perforation (CAP) is an infrequent, yet life-threatening complication of percutaneous coronary interventions, posing a major risk of cardiac tamponade and mortality. METHODS: We report on effective management of Ellis type III CAP with use of double-guiding catheter technique and stent-graft implantation. RESULTS: Prolonged balloon inflation via the first guiding catheter allows for temporary closure of the bleeding site. At the same time, stent-graft is inserted via the second guiding catheter to seal the perforation. After rapid deflation of the balloon, the stent is immediately advanced and expanded. CONCLUSIONS: The procedure minimises the time between deflation of the balloon and implantation of the stent-graft, allowing for successful bleeding cessation.