Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2021; 13(6): 177-182
Published online Jun 26, 2021. doi: 10.4330/wjc.v13.i6.177
Novel economic treatment for coronary wire perforation: A case report
Ahmed Abdalwahab, Conor McQuillan, Mohamed Farag, Mohaned Egred
Ahmed Abdalwahab, Mohamed Farag, Mohaned Egred, Department of Cardiothoracic, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Ahmed Abdalwahab, Freeman Hospital & Department of Cardiovascular Medicine, Tanta University, Tanta 31512, Egypt
Conor McQuillan, Freeman Hospital & Department of Cardiology, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, United Kingdom
Mohamed Farag, Freeman Hospital &School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, United Kingdom
Mohaned Egred, Freeman Hospital &Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE7 7DN, United Kingdom
Author contributions: Egred M conceived and delivered the idea and performed the procedure; Abdalwahab A, McQuillan C, and Farag M were assisting during the procedure and have written and edited the manuscript and produced the schematic figure.
Informed consent statement: The patient provided informed written consent for the publication of this report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Check list (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohaned Egred, BSc, MBChB, MD, FRCP FESC, Consultant Interventional Cardiologist & Honorary Senior Lecturer, Department of Cardiology, Freeman Hospital, High Heaton, Newcastle University, Newcastle upon Tyne NE7 7DN, United Kingdom. m.egred@nhs.net
Received: December 9, 2020
Peer-review started: December 9, 2020
First decision: February 28, 2021
Revised: March 8, 2021
Accepted: March 31, 2021
Article in press: March 31, 2021
Published online: June 26, 2021
Processing time: 194 Days and 20.6 Hours
Abstract
BACKGROUND

Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), however if recognized and managed promptly, its adverse consequences can be minimized. Risk factors include the use of advanced PCI technique (such as atherectomy and chronic total occlusion interventions) and treatment of severely calcified lesions. Large vessel perforation is usually treated with implantation of a covered stent, whereas distal and collateral vessel perforations are usually treated with embolization of coils, fat, thrombin, or collagen. We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation. we advocate this method as a simple method of managing distal vessel perforation.

CASE SUMMARY

A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex. At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation. A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.

CONCLUSION

The use of a balloon remnant for embolization in coronary perforation presents a simple, efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome. Prevention remains the most important part with meticulous attention to the distal wire position, particularly with hydrophilic wires.

Keywords: Percutaneous coronary intervention; Coronary perforation; Coronary guide wire; Collagen; Coronary angioplasty balloon; Coil; Case report

Core Tip: The use of a remnant balloon for sealing a coronary perforation can be a cost-effective method of treating this complication using a readily available material. In cases where the sealing of the perforation is indicated, a careful and controlled approach for delivering the balloon remnant will ensure the safe and effective delivery and the sealing of the perforation which in turn will help stabilize and safe the patient by controlling any further bleeding.