Coronary artery perforation

 Management of coronary artery perforation

1.     Balloon inflation for occlusion of vessel

2.     General circulatory support →
Intravenous fluids and vasopressors

3.     Urgent pericardiocentesis if cardiac tamponade (may consider autotransfusion)

4.     Call anaesthetist and inform surgeons.

Repeat angiogram
↓
Extravasation settled → Yes → Monitor patient
↓
No

#      Large vessel perforation

1.     Prolonged balloon inflation

2.     Covered stent placement

#      Small distal vessel perforation

1.     Embolization (fat, coils, thrombin, balloon fragment)

2.     Covered stent in main vessel over perforated branch origin