First of all, appropriate angiographic evaluation is essential to provide clear imaging of the coronary arteries and their branches. Percutaneous coronary intervention for the treatment of chronic total occlusions (CTO) has made remarkable progress in recent years. This case demonstrates the clinical course of a subepicardial hematoma complicating RCA CTO-PCI, and is unique in its conservative management and The formation of a subepicardial hematoma is a rare complication with very high morbidity and mortality.
However, complications of CTO-PCI remain an important consideration, including coronary perforation and pericardial tamponade. The volume of CTO-PCI procedures is increasing, with higher success rates due to improved techniques and technology. Due to a recent increase in the volume of complex cases, rates of coronary perforation increased in 2016, complicating 2.9% of CTO-PCI and 0.45% of all PCI. Perforation complicates 0.35% of PCI in contemporary series, though numbers have risen in recent years, despite improvements in technology and technique. As it ReviewĬoronary artery perforation is a rare, but grave, complication of percutaneous coronary intervention, caused by wire exit, balloon injury, or plaque modification. This in turn created an active bleeding source that fed and pressurized the space, expanding the hematoma. Initial expansion within this space separated the RCA from the myocardium, avulsing a small penetrating branch. This hematoma was located just within the myocardium. In this patient, we postulate that balloon inflation in the subintimal space, part of the reverse CART procedure, produced a small hematoma in the tissue plane just deep to the RCA and beneath the visceral pericardium. Prior history was notable for coronary artery bypass graft surgery in 2004, with a left internal mammary artery (LIMA) to the left anterior descending artery (LAD), saphenous vein graft (SVG) to the first obtuse Discussion Thus, he was referred for PCI of a right coronary artery (RCA) CTO. A 67-year-old man with a history of diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease (CAD) presented with persistent, daily exertional dyspnea despite optimal anti-anginal therapy.
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