IMAGE IN CARDIOLOGY

DOI: 10.4244/EIJ-D-16-00302

Coronary artery pseudoaneurysm formed after stuck rotablator: IVUS and MDCT findings

Umihiko Kaneko*, MD; Yoshifumi Kashima, MD; Daitaro Kanno, MD; Tsutomu Fujita, MD

An 85-year-old female with a history of coronary artery bypass graft (CABG) surgery underwent PCI of the mid LAD due to an occluded graft. The 1.75 mm burr was suddenly entrapped in the severely calcified and tortuous lesion after rotational atherectomy with a 1.5 mm burr. Ellis type III coronary perforation occurred after retrieval of the burr with manual pullback. Prolonged balloon inflation resulted in successful haemostasis. However, recurrent coronary perforation occurred the following day, and angiography revealed a pseudoaneurysm (arrows) connected to the LAD via a narrow neck with massive contrast extravasation (Panel A, Moving image 1). MDCT (Panel B, Panel C) clearly described the 19.2×21.0 mm pseudoaneurysm connected to the LAD by a narrow neck (arrow) with contrast enhancement (light grey) and some thrombus (dark grey) (Panel B). IVUS imaging (Moving image 2) could visualise an extravascular heterogeneous high-echoic lesion suggestive of partial thrombus formation (Panel D, arrowheads), an extravascular low-echoic lesion suggestive of active blood inflow (Panel E, arrowheads), encapsulated pericardial fluid (Panel E, arrows), and the interrupted external membrane at the perforated site (Panel F, arrows). Finally, we implanted a 2.8×19 mm polytetrafluoroethylene (PTFE)-covered stent, which completely sealed the pseudoaneurysm (Moving image 3, Moving image 4).

Although the stuck rotablator led to delayed coronary perforation, the accumulation of free pericardial fluid was precluded because of the development of pericardial adhesions following previous CABG, and a pseudoaneurysm was consequently formed.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Supplementary data

Moving image 1. Initial coronary angiography revealed recurrent coronary perforation and the pseudoaneurysm connected to the left anterior descending artery via a narrow neck with massive contrast extravasation.

Moving image 2. Initial intravascular ultrasound clearly visualised the interrupted external membrane at the perforated site, active blood inflow into the pseudoaneurysm, encapsulated pericardial fluid, and an extravascular heterogeneous high-echoic lesion suggestive of partial thrombus formation.

Moving image 3. Coronary angiography after PTFE-covered stent placement confirmed the sealing of the pseudoaneurysm with no contrast extravasation.

Moving image 4. Intravascular ultrasound after PTFE-covered stent placement demonstrated the complete apposition of the covered stent and exclusion of the pseudoaneurysm with no blood inflow.

Supplementary data

To read the full content of this article, please download the PDF.

Initial coronary angiography revealed recurrent coronary perforation and the pseudoaneurysm connected to the left anterior descending artery via a narrow neck with massive contrast extravasation.

Initial intravascular ultrasound clearly visualised the interrupted external membrane at the perforated site, active blood inflow into the pseudoaneurysm, encapsulated pericardial fluid, and an extravascular heterogeneous high-echoic lesion suggestive of partial thrombus formation.

Coronary angiography after PTFE-covered stent placement confirmed the sealing of the pseudoaneurysm with no contrast extravasation.

Intravascular ultrasound after PTFE-covered stent placement demonstrated the complete apposition of the covered stent and exclusion of the pseudoaneurysm with no blood inflow.

Volume 12 Number 13
Jan 20, 2017
Volume 12 Number 13
View full issue


Key metrics

Suggested by Cory

Image – Interventional flashlight

10.4244/EIJ-D-19-00227 Apr 20, 2021
Management of a giant dual-chamber pseudoaneurysm of the proximal left anterior descending artery
Grotti S et al
free

CLINICAL RESEARCH

10.4244/EIJ-D-16-01038 Aug 4, 2017
Prevalence and outcomes of coronary artery perforation during percutaneous coronary intervention
Guttmann O et al
free

10.4244/EIJV8I1A23 May 15, 2012
How should I treat guidewire-induced distal coronary perforation?
Senguttuvan N et al
free

IMAGE IN CARDIOLOGY

10.4244/EIJV10I12A253 Apr 20, 2015
Coronary perforation after bioresorbable vascular scaffold implantation
Gomez-Lara J et al
free

10.4244/EIJV10I4A91 Aug 19, 2014
How should I treat an undeployed stent stuck in the proximal LAD? Going for another round...
Locca D and Eeckhout E
free

10.4244/EIJV10I5A111 Sep 28, 2014
Tools & Techniques - Clinical: Management of coronary perforation
Harries I et al
free
Trending articles
309.93

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
166.7

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
92.2

State-of-the-Art Review

10.4244/EIJ-D-20-01296 Aug 27, 2021
Management of cardiogenic shock
Thiele H et al
free
76

State-of-the-Art

10.4244/EIJ-D-23-00840 Sep 2, 2024
Aortic regurgitation: from mechanisms to management
Baumbach A et al
free
72.85

State-of-the-Art

10.4244/EIJ-D-24-00386 Feb 3, 2025
Mechanical circulatory support for complex, high-risk percutaneous coronary intervention
Ferro E et al
free
58.3

Clinical research

10.4244/EIJ-D-23-00344 Sep 18, 2023
Clinical outcomes of TAVI with the Myval balloon-expandable valve for non-calcified aortic regurgitation
Sanchez-Luna JP et al
free
56.65

Clinical research

10.4244/EIJ-D-20-01155 Oct 20, 2021
A deep learning algorithm for detecting acute myocardial infarction
Liu W et al
free
33.9

CLINICAL RESEARCH

10.4244/EIJ-D-17-00381 Oct 11, 2017
Stent malapposition and the risk of stent thrombosis: mechanistic insights from an in vitro model
Foin N et al
free
33.65

State-of-the-Art

10.4244/EIJ-D-23-00606 Jan 1, 2024
Targeting inflammation in atherosclerosis: overview, strategy and directions
Waksman R et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved