A Case Report on Distal Coronary Perforation Following Percutaneous Coronary Intervention with a Sion Blue Guidewire: Cardiac Tamponade Managed by Percutaneous Drainage and Fat Embolisation

Abstract

Coronary perforation is an uncommon yet potentially fatal complication associated with percutaneous coronary intervention (PCI). Distal wire perforations may rapidly lead to cardiac tamponade and hemodynamic collapse if not promptly recognised and treated. The Study reports a case of distal coronary perforation complicated by cardiac tamponade after PCI and demonstrates the successful use of autologous fat embolisation in its management.  We present the case of a 65-year-old male patient who was admitted with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and subsequently underwent percutaneous coronary intervention (PCI) of the proximal left anterior descending artery (LAD).Two hours after the procedure, the patient developed hemodynamic instability secondary to cardiac tamponade caused by distal coronary perforation related to a Sion Blue guidewire. Emergency pericardial drainage was performed with evacuation of 600 mL of hemorrhagic fluid. Persistent bleeding despite prolonged balloon inflation required distal embolisation using autologous fat delivered through a Finecross microcatheter, resulting in complete sealing of the perforation. The patient showed favourable clinical evolution and was discharged after intensive monitoring. This case highlights the importance of early diagnosis and demonstrates the effectiveness of autologous fat embolisation in the management of distal coronary perforations.