Management of coronary artery perforation 1. Balloon inflation for occlusion of vessel 2. General circulatory support → Intravenous fluids and vasopressors 3. Urgent pericardiocentesis if cardiac tamponade (may consider autotransfusion) 4. Call anaesthetist and inform surgeons. Repeat angiogram ↓ Extravasation settled → Yes → Monitor patient ↓ No # Large vessel perforation 1. Prolonged balloon inflation 2. Covered stent placement # Small distal vessel perforation 1. Embolization (fat, coils, thrombin, balloon fragment) 2. Covered stent in main vessel over perforated branch origin
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