Iatrogenic Brachiocephalic Artery Trunk Perforation Successfully Treated with Percutaneous Implantation of Covered Stent

Abstract

Percutaneous coronary intervention through right radial artery access significantly reduces vascular complications compared to femoral access—an 80-year-old woman presented with non-ST segment elevation acute coronary syndromes (NSTE ACS). Coronary angiography performed using right radial artery access showed left anterior descendent artery disease with multiple stenoses, which was treated percutaneously. Ten minutes after the procedure, the patient presented dyspnea, hypotension, neck edema, and jugular turgor. She was immediately intubated and treated with invasive ventilation, fluid expansion, corticosteroids, and vasopressors. Urgent computerized tomography showed brachiocephalic artery trunk dissection and perforation with extravascular hemorrhage in the mediastinum and neck with venous compression without any sign of aortic, carotid, or subclavian dissection. Two days later, the percutaneous endovascular repair was performed, and a covered self-expanding stent was successfully positioned in the brachiocephalic trunk, sealing the perforation and treating the dissection. The patient progressively recovered and was discharged for rehabilitation. We provided the first report of a brachiocephalic trunk perforation using a radial approach, causing mediastinal and neck hematoma treated with percutaneous endovascular repair showing that vascular complications can be successfully treated percutaneously if be performed by an experienced team.