Dynamic Intravascular Ultrasound Changes Mimicking Membrane Disruption in a Covered Stent During Management of Coronary Perforation

Abstract

A blowout-type coronary perforation occurred following rotational atherectomy at the LCX ostium. Hemostasis was attempted with sequential deployment of PK Papyrus covered stents at the LCX ostium and from the left main trunk to the LAD; however, contrast extravasation persisted. Serial IVUS demonstrated progressive attenuation of the characteristic high-intensity stent signals, raising concern for covered membrane disruption. Additional covered stenting with a Graftmaster and PK Papyrus nevertheless failed to achieve complete sealing of the perforation.