case_images: PMC7251425_01
case_images: Coronary angiography of the patient. (a) CTO of RCA. (b, c) Collaterals from LAD to RCA territory. Retrograde filling of RCA. (d) LAD/D1 bifurcation lesion.
case_images: CRIC2020-9493519.001.jpg
case_images: PMC7251425_01_CRIC2020-9493519.001.jpg
case_images: fig1
case_images: A new invasive coronary angiography (ICA) showed no significant changes in comparison with previous findings (Figure 1).
case_images: Ellis type III RCA perforation.
case_images: CRIC2020-9493519.002.jpg
case_images: PMC7251425_01_CRIC2020-9493519.002.jpg
case_images: fig2
case_images: III perforation of the vessel was caused (Figure 2), as the balloon predilatation was found to have been implemented in an acute marginal branch that ran parallel to the main vessel. Inflating a balloon proximally to the perforation was intended to stop further blood extravasation.
case_images: (a) Extravasation causing cardiac tamponade. (b) Urgent pericardiocentesis under fluoroscopic guidance.
case_images: CRIC2020-9493519.003.jpg
case_images: PMC7251425_01_CRIC2020-9493519.003.jpg
case_images: fig3
case_images: Urgent pericardiocentesis under fluoroscopic guidance (Figure 3) fortunately stabilized the patient.
case_images: Final angiographic results. (a) CTO PCI of RCA; (b) PCI of LAD/D1 bifurcation lesion.
case_images: CRIC2020-9493519.004.jpg
case_images: PMC7251425_01_CRIC2020-9493519.004.jpg
case_images: fig4
case_images: The final angiographic result of the CTO PCI of the RCA was very good (TIMI flow grade 3) (Figure 4), and the patient was transferred to the coronary care unit being hemodynamically stable and asymptomatic. An excellent angiographic result was finally succeeded (Figure 4), and 3 days later, the patient was discharged being asymptomatic.