Lethal Left Anterior Descending Perforation in Anterior Myocardial Infarction During Primary Percutaneous Coronary Intervention. A Rare Case Finding and Literature Review

Abstract

Introduction: Artery perforation during Percutaneous Coronary Intervention (PCI), is a rare but potentially life-threatening complication that may occur during cardiac catheterization procedures.

Case Illustration:  A 57 years old male with chest pain sought for further medical care due to persistence in chest pain. The clinical case shown is a match for acute coronary syndrome (ACS). During angiography study, perforation occurred seemingly radiates towards distal with every intervention given to stop perforation in the proximal.

Discussion. It is important to assess ACS at once to reduce myocardial death. The potential perforation evident in our observation from the replay may be attributed to severe calcification at the lesion, potentially fostering cavitation-induced plaque rupture, collateral perforation, indicating a blood supply from a ruptured collateral artery, guidewire dissection of subintimal, causing the wire to enter the subintimal space rather than the true lumen of the blood vessel, and may create a small dissection in artery and lead to rupture. Employing an angiographic categorization system proves to be of significant value in guiding the treatment strategy.