Recurrent Coronary Perforations in an Aneurysmal Coronary Artery Treated with Covered Stent

An elderly hypertensive lady presented to us with acute coronary syndrome; an angiogram revealed total thrombotic occlusion of large left circumflex artery. After thrombosuction, there was proximal tight stenosis followed by an aneurysmal segment of the culprit vessel that was stented successfully. Subsequent post-dilatation at the site of aneurysm produced a large perforation, which was sealed off immediately with a covered stent. Unfortunately, the patient had sudden cardiac tamponade and arrest later in the intensive cardiac care unit due to repeat perforation, and could not be resuscitated from this complication. Aneurysmal and ectatic arteries have fragile walls and aggressive post-dilatation for achieving optimal stent apposition should be avoided.