It was reported that a perforation occurred requiring additional intervention.The patient presented with a subacute anterior myocardial infarction.Coronary angiogram revealed 50% stenosis with severe calcification of the left main coronary artery (lmt) and 90% stenosis with severe calcification of the left anterior descending artery (lad).The target lesion, located in the lad, was debulked using rotational atherectomy as intravascular ultrasound (ivus) was unable to be performed.A 1.50mm burr was selected, followed by additional debulking with a 1.75mm burr.Pre-dilation of the lesion was completed using a 2.50 mm wolverine cutting balloon.Balloon indentation disappeared and a contrast leakage was then observed from the proximal lad.In an attempt to establish homeostasis, a 2.50 mm non-scientific balloon was introduced with multiple extended inflations, but homeostasis was unable to be achieved.A 2.50 x 10 mm non-boston scientific stent was then deployed in the lad, but bleeding continued.Ivus showed a disruption in the vessel wall due to a crack in the calcification of the distal lmt, evidencing a hemorrhage from the same area via the adventitia.A 3.00 x 15 mm non-boston scientific stent was deployed in the lmt to lad, but homeostasis was not achieved.Finally, a 3.00 x 20 mm non-boston scientific covered stent was deployed over the previous stent, occluding the left circumflex.Homeostasis was successfully achieved after difficulty locating the perforation site.
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B3 date of event was estimated based on aware date as no event date was provided."mp29-8_a case of lmt perforation with difficult hemostatic site identification and hemostasis," was on a poster presentation at a conference held on friday, august 4, 2023 in fukuoka, japan.
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