“Kissing-Balloon” Angioplasty Associated Coronary Artery Perforation in Anterior STEMI: A Cautionary Tale

Abstract

Introduction: Bifurcation technique angioplasty remains one of the most challenging procedures in interventional cardiology, up to 10% of patient with STEMI present with a bifurcation as the culprit lesion. Coronary artery perforation is a known complication of percutaneous coronary intervention and complex coronary anatomy is often posed as a risk factor. Interventional and surgical management of coronary artery perforation is indicated as soon as possible. Case presentation: A 55-year-old male was admitted to the emergency room with severe chest pain 12-hour prior to his admission. An anterior STEMI was diagnosed, and the patient underwent emergency coronary angiography with a bifurcation lesion of the mid LAD and D1, after transient loss of anterograde flow a secondary vessel a “kissing-balloon” technique was performed and type III coronary artery perforation in the Ellis classification of the side-branch was identified. Patient developed cardiogenic shock and urgent thoracotomy was performed. The patient was discharged in good conditions. Conclusion: Coronary artery perforation is a feared complication of percutaneous coronary intervention. Chest pain and hemodynamic deterioration can quickly lead to patient’s death. Identification as soon as possible and interventional or surgical management must be performed.