The Complication of Coronary Artery Perforation Beyond Cardiac Tamponade During Percutaneous Coronary Intervention: the Review of the Anaphylaxis of Contrast Medium

A 72-year-old male presented with unstable angina and was admitted for a coronary angiography that showed in-stent restenosis and diffuse stenosis at the Diagonal branch (DB1) and the left anterior descending coronary artery (LAD), respectively. A high-pressure balloon was chosen to dilate the bifurcation of DB1 and LAD due to difficult advancement of drug-eluting stent. Unfortunately, a coronary perforation was noted at the distal LAD after successful stenting. Afterward, a small balloon was inflated near the distal perforated LAD and Heparin was reversed with protamine immediately. Nonetheless, the patient started to develop chest tightness and his blood pressure dropped to 78/43 mmHg. The echocardiogram showed no pericardial effusion, but facial edema of the patient was observed. The patient were improved after the appropriate rescue therapy for anaphylactic shock. This catastrophic complication reminds us the importance of any other possible hazards of coronary perforation beyond cardiac tamponade.