Журнал васкулита

Coronary angioplasty can be complicated by pericarditis which can appear at distance or more rarely early after the procedure, especially in the event of a mechanical complication of this procedure such as coronary artery perforation.

Summary of the case: We report the case of a patient who presented with early pericarditis after angioplasty complicated by coronary perforation.

It is about a 58-year-old patient admitted for angioplasty of a chronic total occlusion of the right coronary artery; the angioplasty resulted in a coronary perforation through the guidewire 0.014. The patient remained asymptomatic and hemodynamically stable. Faced with the failure to exclude the perforation by balloon inflation, we decided to perform a distal fat embolization to seal the perforation.

Twelve hours after the procedure, the patient presented with intense chest pain with a concave elevation of the ST segment in the anterior and lateral leads with an increase in troponins level and a worsening of the pericardial effusion on echocardiography motivate an emergency coronary angiography which confirms the absence of an active perforation. An elevated C-reactive protein level confirmed the diagnosis of acute pericarditis leading to the start of anti-inflammatory treatment allowing sedation of the pain, normalization of the ECG and regression of the effusion thus authorizing the patient's discharge 5 days later.

Coronary perforation during angioplasty has, in addition to these immediate hemodynamic consequences, a risk of progression to so-called traumatic acute pericarditis and should prompt rigorous monitoring of inflammatory signs and the systematic initiation of anti-inflammatory treatment (Aspirin or non-steroidal anti-inflammatory drugs and Colchicine) after the acute management of the perforation in order to reduce the long-term morbidity and mortality of this complication and the progression towards constriction.

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