During a procedure to recanalise a chronically occluded rca , a 7f al-1 launcher guide catheter with side holes was placed in the rca ostium and a 7f ebu3.5 launcher with side holes was placed in the lm.A femoral approach was used.A non-medtronic wire was placed in the distal diagonal beyond the subtotal occlusion of the lad but the lad itself could not be reached.Therefore, a balloon dilatation with a non-medtronic device was attempted to enable access across to the lad.The non-medtronic balloons would not cross.During these attempts, the patient complained of severe chest pain and developed hypotension.Immediate angiography of the lm showed an ostial perforation of ellis grade iii into the aortic wall.A covered stent was used to treat the perforation.Patient experienced occlusion due to covered stent positioning which was then treated.The patient was eventually discharged with improved clinical symptoms.Follow-up was uneventful until last phone contact 6 months later.
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