Hand Made Covered Coronary Stent Seals type 3 Coronary Perforation–A Life Saving Procedure When Ready to use Covered Stents are Unavailable

Abstract

Coronary perforations are classified as type 1-extra luminal crater, type 2-myocardial or pericardial blushing, and type 3-contrast streaming or cavity spilling. Type 3 coronary perforations are associated with high mortality. Treatment modalities of Type 3 coronary perforations include prolonged balloon inflation, pericardiocentesis for cardiac tamponade, coronary artery bypass surgery, and micro coil embolization. A new technique, widely practised, consists of deploying one or more ready to use covered coronary stents to seal the perforation. This has reduced the need for emergency Coronary artery bypass surgery. The author describes here a case of coronary perforation Type 3 occurring unexpectedly after deploying a drug eluting stent across a simple mid left anterior descending artery lesion combined with a situation of non-availability of ready-to-use covered coronary stent in the catheterisation laboratory. A innovative technique of making by hand a covered coronary stent using readily available coronary balloon to cover an appropriately sized coronary stent is described. This handmade covered stent was deployed to seal the coronary perforation successfully and was
life saving.