A sapphire balloon was used in the left main (lm) and proximal circumflex (cx) artery as well as with an obtuse marginal lesion following eight atherectomy treatments on low speed.Angiography was performed after atherectomy, and no issues were noticed.Angioplasty and stent placement were performed in the om and cx.Following the second post dilation in the cx with the sapphire balloon, extravasation was noted in the area of the stent.A second balloon was used for tamponade, but the patient responded poorly.A second stent was deployed within the first stent to cover the perforation.The patient then became hemodynamically stable and was eventually transported to the cardiac care unit in stable condition.The procedure was delayed by 30 minutes or more.The patient received additional pressors, and extra saline.The physician stated the sapphire nc plus caused the perforation and that the balloon was too stiff.The physician stated csi's oad did not play a role in the perforation.
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