Conservative Management of Coronary Perforation: Lessons from the Oleander Bloom.

This is a case report of a 62-year-old male patient who developed coronary perforation during a percutaneous coronary intervention. He presented with a non-ST-elevation MI and had a history of hypertension and hypercholesterolaemia, with an elevated BMI. Coronary angiography revealed severe calcific coronary disease within an angulated proximal left anterior descending artery. Following a heart team meeting, the consensus was for complex percutaneous coronary intervention to the left anterior descending artery, with or without left main stem involvement. Following initial balloon dilatation within the left anterior descending artery there was a clear coronary perforation. The operators could not advance a balloon past the point of perforation. It was thought that a calcific spur was preventing this. The patient suffered no acute haemodynamic compromise and there was no evidence of pericardial effusion on bedside echocardiography. After a period of observation, the operators made the decision to stop. The patient remained in the cardiac care unit on dual antiplatelet therapy for 2 weeks. The operators then brought the patient back to the laboratory and completed the case with relative ease. This case highlights the potential for conservative, non-surgical management in selected patients with contained coronary perforations, suggesting that appropriate monitoring and pharmacotherapy can mitigate the risks associated with invasive correction.