Abstract
Background A 63 years old male patient, manual worker. Known hypertensive 10 years ago, not diabetic nor smoker. Presented by unstable angina over the last week. Coronary angiography was done and revealed a long diseased middle LAD segment with maximum area of stenosis around 95%, diseased 1st Diagonal branch and 85% focal non dominant LCX lesion. Percutaneous intervention for LAD was done using bare metal stent. After PCI, the patient started to complain of severe chest pain. Coronary angiography revealed coronary perforation and the presence of die in the pericardium. Graft stent was not available in the cath lab. A non complaint balloon was advance to the site of perforation and inflated for recurrent short intervals with partial relieve of chest pain. A decision for surgical intervention was done, but there was no surgical back up team available at that time. A second decision was done which was creating a manual graft stent by shedding a 2.5 × 15 mm balloon and reposition it over a second 2.75 × 15 mm bare metal stent and advanced to the site of perforation and inflated up to 16 atm with very good final result and acute relieve of chest pain and complete disappearance of stagnant die for the pericardial sac. The patient was symptom free over his hospital stay for 48 h. Clinical follow-up was done every month in the outpatient clinic.
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