DOI: https://doi.org/10.36347/sjmcr.2026.v14i08.027

Pages: 1879-1881

The coronary artery perforation during elective percutaneous coronary intervention is a nightmare for interventional cardiologists and one of the most common complications that lead to cardiac tamponade and is always hard to manage timely and properly [1]. We report the case of a 76-year-old male who developed a paroxysmal supraventricular tachycardia with an accelerating chronic coronary syndrome due to a significant mid-left anterior descending artery [LAD] stenosis involving the first diagonal bifurcation. During provisional stenting of the mid-LAD with protection of the diagonal branch via a jailed guidewire, hemodynamic instability and cardiac tamponade occurred secondary to distal perforation of the first diagonal branch by the protection wire. Pericardiocentesis, transfusion and a covered stent deployed across the mid-LAD, deliberately sacrificing the diagonal branch ostium restored a hemodynamic stability and a satisfying result was achieved.