Iatrogenic perforation of the left atrium and aorta during transseptal puncture (TSP) is a rare but potentially life-threatening complication. This report presents the case of an elderly male patient with a 20-year history of atrial fibrillation who experienced this complication during a scheduled left atrial appendage closure procedure. During the procedure, the sheath inadvertently penetrated the left atrial wall and mediastinal tissues, resulting in perforation of the descending aorta. To prevent hemorrhage and secondary injury, we successfully repaired the defects by simultaneously deploying two ductus arteriosus occluders through the original access tract. Immediate post-procedural and 1-month follow-up assessments confirmed stable device position with no residual shunt, pericardial effusion, or thromboembolic complications. This case represents the first documented instance of concurrent closure of both left atrial and descending aortic perforations using ductus arteriosus occluders. It highlights the critical importance of prompt intervention for complex cardiac complications and demonstrates the feasibility of dual-chamber repair using occluder devices.
Radial artery pseudoaneurysm (PSA) is an uncommon but clinically relevant complication increasingly encountered with the expanding use of radial access in cardiology and critical care. Presentation and management vary widely according to etiology, patient frailty, and arterial wall integrity. We describe two representative cases: an elderly diabetic woman who developed a PSA after complex transradial coronary stenting and was successfully treated with selective coil embolization, and a man with cardiogenic shock and sepsis who developed a PSA following prolonged invasive monitoring and was managed with vascular plug devices. These cases illustrate the heterogeneous mechanisms leading to PSA and emphasize the need for individualized endovascular strategies in complex patients.
Drug-coated balloons (DCB) have emerged as a promising stentless strategy in percutaneous coronary intervention, but their role in ST-elevation myocardial infarction (STEMI) involving large de novo coronary arteries remains uncertain. This systematic review and meta-analysis evaluated the clinical and angiographic outcomes of DCB compared with drug-eluting stents (DES) in STEMI patients with large bservational cohorts. The primary outcomes were target lesion revascularization (TLR), major adverse cardiac events (MACE), myocardial infde novo coronary lesions (≥ 2.5 mm). A comprehensive search of PubMed, Scopus, and Web of Science was performed up to July 1, 2025, including randomized controlled trials, non-randomized trials, and oarction (MI), and cardiac and all-cause death; angiographic endpoints included minimal lumen diameter (MLD) post-PCI and at follow-up, and late lumen loss (LLL). Four studies comprising 1428 patients were included. There were no significant differences between DCB and DES in TLR (RR = 1.16, 95% CI: 0.62–2.17, p = 0.65), MACE (RR = 1.59, 95% CI: 0.64–3.97, p = 0.32), cardiac death (RR = 1.07, 95% CI: 0.55–2.09, p = 0.84), or MI (RR = 1.20, 95% CI: 0.77–1.87, p = 0.42). Post-PCI MLD was significantly higher with DES (MD = –0.29 mm, 95% CI: –0.39 to –0.20, p < 0.00001), whereas follow-up MLD did not differ significantly between groups (MD = –0.26 mm, 95% CI: –0.62 to 0.11, p = 0.17). LLL was comparable (MD = 0.02 mm, 95% CI: –0.08 to 0.11, p = 0.73). These findings suggest that DCB represents a safe and effective alternative to DES in STEMI patients with large de novo coronary artery lesions.
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