Multiple coronary artery perforation following global pericardial tamponade in a patient with prior coronary artery bypass graft surgery: a case report

BACKGROUND: Patients who undergo coronary artery bypass graft (CABG) surgery rarely develop global pericardial tamponade due to pericardial adhesions. There are no reports of multiple coronary artery perforations following global pericardial tamponade during percutaneous coronary intervention (PCI) in these patients. CASE SUMMARY: A 52-year-old male who underwent CABG surgery developed effort angina pectoris. Coronary angiography demonstrated chronic total occlusion (CTO) of the first diagonal branch with severe stenosis of the second diagonal branch. Because his chest pain did not improve with medical therapy and ischaemia of the left ventricular anterolateral wall was confirmed by myocardial scintigraphy, PCI was performed. The second diagonal branch stenosis was passed anterogradely by a 0.014-inch coronary angioplasty guidewire, while the first diagonal branch CTO was recanalized by side-branch intravascular ultrasonography-guided parallel wiring. After stent deployment, coronary artery perforation at the distal end of the second diagonal branch was detected via contrast injection. We immediately performed intravascular haemostasis, leading to the disappearance of contrast. However, multiple bleeding sites were visualized by angiography at different sites of coronary arteries, including the circumflex artery. Although intravascular haemostasis is a standard procedure, we could not control rebleeding. Despite intensive care, the patient died. DISCUSSION: Increased tissue pressure due to bleeding possibly led to global pericardial tamponade with multiple coronary artery perforations. We report a rare case of a patient with multiple coronary artery perforations during coronary intervention.