K. ALAMI, N. EL KARROUMI, M. ANGIOI, M.AMOR
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 5
Date of Publication: 2026/05/24
Severely calcified coronary lesions remain a major challenge in percutaneous coronary intervention (PCI), often requiring plaque modification strategies such as rotational atherectomy or excimer laser coronary atherectomy. Although these techniques improve lesion preparation and stent delivery, they are associated with specific procedural complications, including coronary perforation. We report the case of a 71- year-old woman with multiple cardiovascular risk factors who presented with exertional dyspnea and evidence of inferior myocardial ischemia. Coronary angiography revealed a tortuous and severely calcified proximal-to-mid right coronary artery with a critical stenosis. Initial lesion modification using rotational atherectomy failed due to lesion resistance, leading to the use of excimer laser coronary atherectomy. The procedure was complicated by coronary perforation resulting in cardiac tamponade. The patient was successfully managed with emergent pericardial drainage, prolonged balloon inflation, and implantation of a covered stent. This case highlights the challenges of managing heavily calcified coronary lesions and reviews the spectrum of complications associated with coronary atherectomy techniques, with a particular focus on coronary perforation and its management.
coronary calcifications, atherectomy, rotablator, laser, coronary perforation
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