Acute left anterior descending artery occlusion after IVUS leading to urgent percutaneous coronary intervention complicated with coronary perforation: Case report.

Abstract

Background: Intravascular ultrasonography (IVUS) has become an important complementary tool in interventional cardiology, both for preprocedural planning and for optimizing the performance of percutaneous coronary intervention (PCI). However, this tool is not free of potential complications, because of that it is essential to be aware of them and their management. Over time, new uses of IVUS have emerged, and it is currently a potential tool for predicting the risk of coronary perforation.

Case report: We present the clinical case of a 51-year-old male patient who was admitted in the context of post-infarction angina. During coronary angiography, the patient presented with two acute complications, one of them associated with IVUS and the other associated with severe coronary calcification that predisposed to coronary perforation. Both complications were successfully treated.

Conclusion: IVUS, although a very useful imaging tool before and during PCI, is not without risk. The overall rate of complications with certain or possible relation to IVUS is 3.9%. Vascular spasm is the most frequent complication and acute vascular occlusion, with the need for emergency coronary artery by-pass grafting, the least frequent. On the other hand, IVUS can predict the risk of developing other complications, such as coronary perforation, by means of the C-CAT sign. Knowledge of the possible complications during PCI and the rapid procedure of the hemodynamic team allows adequate management of these potentially fatal complications.