A late complication of coronary artery perforation during primary percutaneous coronary intervention: Coronary arteriovenous fistula

Coronary artery perforation (CAP) is a rare, but potentially mortal possible complication of percutaneous coronary intervention. There are several treatment options for this complication, including prolonged balloon dilatation, use of a coronary stent graft, and bypass surgery. In this case report, a 65-year-old female patient who was admitted to the catheter laboratory with a diagnosis of acute coronary syndrome, was presented. Coronary angiography revealed total occlusion in the mid segment of the right coronary artery and a drug-eluting stent was implanted under 12 atm of pressure following pre-dilatation with a perfusion balloon. In order to perform defragmentation of the thrombus shifted into the proximal stent segment, post-dilatation was performed with a stent balloon (4–6 atm). After post-dilatation, an Ellis Class II perforation developed. In order to control the bleeding, a coronary stent graft was implanted at the perforation area. The rupture was sealed. Control coronary angiography 40 days later indicated that the stent graft was patent, but an arteriovenous fistula (AVF) draining to the right ventricle was detected. To the best of our knowledge, this is the first case of AVF seen as a late complication of CAP treated with a stent graft.