Coronary fat embolization for late coronary perforation. I did a routine DK-crush bifurcation PCI. 6 hours later, pt is hypotensive with a large effusion. Relook angio showed diagonal tip perforation that wasnt there at the end of PCI. Prolonged balloon tamponade failed. Coils unavailable. Treated with autologous fat embolization,... an effective bailout technique. • Small 0.5 cm groin incision • Subcutaneous fat harvested using forceps into small bowl • Fat mixed with saline • Loaded into a 2 cc syringe • Using a microcatheter (Turnpike/Finecross/Export, etc.), to inject fat into the perf site. • Final angiography confirmed complete seal. Join us at TCTME+ in Sep 2026. Will have a lot of great #CHIP and complications discussions. J Aaron Grantham JAG Dany Jacob Altayyeb Yousef Wail AlkashkariFSCAI,FPICSوائل القشقرى🇸🇦🇨🇦🇺🇲 MIЯVΛƬ #IC ༄ ｡° Aref BinAbdulhak MD MSc Amr Mohsen, MD Marwan Saad Abdallah El Sabbagh Musa A. Sharkawi David J. Cohen, MD, MSc Mohammed Qintar, MD MSc Muhammad Hammadah Karim Al-Azizi, MD Adam Greenbaum Mohammed Al-Hijji Emory University Juan Del Cid Fratti MD MSc Anton Camaj, MD Cardiovascular Research Foundation David J. Cohen, MD, MSc Mamas A. Mamas TCTME+ Cardiovascular Research Foundation Hooman Bakhshi Abdelkader Almanfi, MD, FACC, FSCAI إبراهيم الحربي Ibrahim Alharbishow more

In a similar scenario I used a different technique: I kept the distal wire position, cut a small balloon, advanced the distal balloon segment over the wire beyond the perforation site, and used it as a mechanical plug. Final angiography showed complete seal.

Interesting case, Anas. Hypotension with a large effusion post-PCI raises concerns. Could there have been vessel dissection or microvascular obstruction that wasn't evident initially? Was intravascular imaging utilized during the procedure to assess the stent placement? If yes, what findings did it reveal? #Medicine For a deeper dive into cases like this and to generate comprehensive biomedical reviews on similar topics, explore Sci-Quest, a one-stop platform for every biomedical question you might have:

@Sh_Zaynobidinov Nice one..I did one for a RCA perforation. Really did the job. Thanks for sharing

We did a recent case similarly. We also injected the distal end of coronary wire after cutting it

Yes, that works too.

Daring rescue

Impressive bailout technique. Autologous fat embolization is an elegant solution when conventional methods fail. I look forward to TCT ME 2026.

@AlkashkariWail Great save Anas

Great case. Do u recommend mixing fat with contrast?

I didnt do it in this case. I think its helpful to do though.

What about the risk of infection?

Probably similar to coils. No head to head comparison. Although if you look up the data, you might conclude that infection risk is higher with coils than fat embolism.

great save

👏🏻👏🏻👏🏻

What is the advantage over using a coil ?

Only when you don’t have coils

Absolutely

@Almanfi_Cardio Bravo! Great medicine and happy patient!