Delayed Distal LAD Perforation After Elective PCI: Successful Treatment with Coil Embolization

Although uncommon, coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) can lead to serious, potentially fatal outcomes.The risk of CAP is notably higher during complex coronary interventions, particularly in cases involving chronic total occlusions (CTO) and heavily calcified lesions. Early recognition and prompt management of life-threatening consequences such as cardiac tamponade are critical for improving patient outcomes and reducing mortality. Management strategies vary depending on the severity and location of the perforation and may include prolonged balloon inflation, the implantation of covered stents, pericardiocentesis, or coil embolization for distal vessel perforations. In this report, we present a case of distal left anterior descending artery (LAD) perforation leading to cardiac tamponade, successfully managed with emergency pericardiocentesis and coil embolization.