Complications Related to Coronary Stenting

Abstract

A 70-year-old woman was referred for possible coronary intervention for an ostial right coronary stenosis discovered during a workup for chest pain where an abnormal nuclear stress study had revealed inferior wall ischemia (Figure 6-1). The coronary intervention was performed using a 7 French Judkins right guiding catheter with predilatation of the area, followed by subsequent stent implantation of a 4.0 = 18-mm stent (Figure 6-2). An additional inflation was performed at 14atm with a short balloon to assure good stent deployment. The patient left the laboratory without any complaints, but 3 hours later, she developed some moderate chest discomfort, unlike her previous angina. She was given sublingual nitroglycerin, and subsequently developed sinus bradycardia and mild hypotension. An electrocardiogram obtained during that time was normal. She was given intravenous fluids with some response, but soon developed progressive hypotension and bradycardia. Cardiopulmonary resuscitation was begun when she lost both pulse and consciousness. Urgent echocardiography followed by bedside surgical subxyphoid exploration confirmed the suspected hemopericardium. Open image in new window Figure 6-1. Right coronary angiogram showing left anterior oblique projection. There is a significant lesion at the ostium, confirmed by nonselective injections and not relieved by intra-coronary nitroglycerin. Open image in new window Figure 6-2. (A) Balloon angioplasty was performed without incident followed by stent deployment and high-pressure dilatation with a short balloon. (B) Final angiogram after stent implantation.