Coronary rupture after stent deployment in a patient under chronic immunosuppressive therapy.

Coronary rupture during cardiac catheterization and angioplasty is an uncommon but serious complication. Predisposing factors to this dreadful complication are not well defined. We present a case of coronary artery rupture during an urgent percutaneous intervention in a patient under chronic immunosuppressive therapy with corticosteroids and azathioprine, despite intravascular ultrasound (IVUS) guidance. Initially, the perforation was successfully managed with balloon inflation and finally, a covered stent was deployed at the site. The unexpected rupture, despite optimal IVUS sizing, indicates a possible role of immunosuppressive therapy in coronary artery wall vulnerability. Extra caution should be exerted in such patients while performing coronary interventions and using intracoronary devices.