Management of Distal Coronary Perforation by Fatty Autologous

During percutaneous coronary intervention (PCI), distal coronary perforation is an unexpected side effect. Although the initial step to treating a perforation is temporary inflatable occlusion of the proximal coronary artery, more permanent alternatives for treatments include fat/coil embolization for distal vessel perforations or covered stent deployment for large vessel perforations. We report a case of a 72-year-old woman who presented with chest pain. Coronary angiography showed a 90% stenosis in the left anterior descending (LAD) artery II segment. The PCI of the culprit vessel was challenging due to tortuous and calcified vessel lesions in the LAD. It was complicated by distal coronary perforation due to excessive wire movement. We performed fat embolization using a FineCross microcatheter that successfully sealed the perforation.