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Coronary artery rupture is a rare complication of balloon angioplasty. Techniques used in its management include emergency surgery, covered stent deployment, and microcoil vessel occlusion. The latter has been reported twice. We report a further case of successful coil occlusion of a ruptured coronary artery following angioplasty.
A 53 year old man presented with unstable angina. Angiography demonstrated occlusion of the first obtuse marginal artery. Balloon angioplasty using a 2 mm balloon was undertaken with deployment of a 2.5 × 18 mm stent (S670, Medtronic).
Shortly after stent deployment, the patient became haemodynamically compromised and angiography showed perforation of the obtuse marginal artery distal to the stent site (below left).
The pericardium was drained percutaneously. The patient continued to haemorrhage at a rate of 50 ml/min into the pericardium. Covered stent deployment was not considered feasible because of the calibre of the distal vessel at the site of perforation. Coil occlusion of the obtuse marginal artery was therefore performed, using six 2 × 10 mm and two 2 × 5 mm fibred platinum coils (Target Therapeutics) (below right). There was no further extravasation on contrast injection and no further blood was aspirated from the pericardium. The patient sustained a rise in creatinine kinase to a peak of 444 IU/l, but otherwise made an excellent recovery and was discharged one week later.