We would like to report the case of a 66-year-old woman who developed a fatal left ventricular perforation following stenting of a long lesion of left anterior descending (LAD) artery. She was a known diabetic with a past history of hypertension and had NYHA class III angina. The LAD had a long lesion with a small diagonal branch arising from the lesion (Figure 1). The left circumflex artery and right coronary artery had mild disease. Left ventricular function was normal.
The patient underwent coronary angioplasty. The balloon result being sub optimal, a long stent (3mm 3 40mm) (Microstent II, Advanced Vascular Engineering, Richmond, Canada) was deployed at 12 atmospheres with a good result. During the procedure, a diagonal artery that was less than 1.5 mm in diameter was compromised (Figure 2). The patient complained of mild chest pain and had 0.5 mm ST elevation in leads I, aVL, V3 & 4. Since the area affected was small, we decided to treat the patient conservatively. However, in view of the persistent chest pain, a repeat angiogram was done 4 hours later. It showed that the stented LAD segment was widely patent with brisk flow to the distal LAD. The occluded diagonal artery was not visualized. The chest pain subsided in a few hours.