Complex Treatment of a Coronary Bifurcation Perforation With a Dual-Covered Stent Strategy.

Background: Perforation of a major epicardial coronary artery during percutaneous coronary interventions (PCIs) is potentially lethal.

Conclusions: Here the authors present a novel treatment strategy for managing a perforation in the bifurcation core with a complex 2-stent technique using polyurethane-covered stents. Specialized equipment for chronic total occlusion (CTO) interventions was used for recanalization of the main vessel and side branch. The procedure was tested in a bench setting and validated using 3-dimensional optical coherence tomography and micro-computed tomography. Conclusions: The case emphasizes the need for complex CTO-PCI techniques in the treatment of acute non-CTO PCI. To the best of our knowledge, this is the first report of a complex bifurcation technique for treatment of an epicardial perforation. Conclusions: It is feasible to treat an epicardial perforation in the bifurcation core with an advanced 2-stent technique. Ex vivo training for rare and severe complications may improve procedural outcome.