Coronary artery perforation: How to treat it?

AbstractCoronary artery perforation fortunately represents a rare complication of coronary catheterization but, if not properly and promptly treated, it is burdened by a high mortality rate. Rates of coronary perforation may be potentially higher when atherectomy devices are used or very complex calcified lesions are treated. Cardiac tamponade constitutes the most severe clinical consequence.We report the case of an intra-stent coronary perforation at the end of revascularization of a non-ST elevation myocardial infarction (NSTEMI), followed by an immediate impairment of hemodynamic compensation, due to significant pericardial effusion and subsequent cardiac tamponade.The use of covered stents has revolutionized the management of coronary perforation and this has meant that the use of emergency CABG has decreased over the years with satisfactory immediate and short-term outcomes, reducing the incidence of acute cardiac tamponade and mortality without surgery

In-stent restenosis: COMBO stent may guarantee a proper healing

A 55-years-old man with coronary risk factors hypertension, hypercholesterolemia, history of smoking, diabetes mellitus in insulin treatment with poor control of blood glucose levels was admitted at our department for non-ST elevation myocardial infarction (NSTEMI)

Late Malapposition After Bare-Metal Stent, But Not Bioresorbable Scaffold: Insights on Intraindividual Heterogeneity in Plaque and Device Response

We present a case of late acquired bare-metal stent malapposition and uncovered struts, visible at angiography and confirmed by optical frequency domain imaging. In the same patient, an everolimus-eluting biovascular scaffold in another vessel was well apposed and all struts were covered. This case highlights the potential heterogeneity in the evolution of atherosclerotic plaques and response to different devices in the same patient