Coronary artery perforation into the upper gastrointestinal cavity due to gastric ulceration

An 82-year-old man who had previously undergone a proximal gastrectomy with jejunal interposition surgery for stomach cancer was transferred to our hospital for massive hematemesis and hypotension. His electrocardiogram showed ST-segment elevation in lead ΙΙ, ΙΙΙ, aVF, which confirmed inferior myocardial infarction. Due to active hematemesis, upper endoscopy was performed initially. A visible vessel of gastric ulceration was discovered, and hemostasis was achieved using hemoclips. Subsequently, coronary angiography was performed since the right coronary artery (RCA) segment 4 atrioventricular (AV) was occluded. After thrombectomy and intravascular ultrasound (IVUS), 2.0 mm balloon angioplasty was done, and coronary perforation occurred. During coronary angiography, extravasation of the contrast material into the gastrointestinal cavity was noted. A covered stent was placed across segment 3 to segment 4 descending posteriorly (PD) to stop the blood supply to the perforation site of segment 4 AV. After stenting, adequate re-hemostasis was achieved. The patient was discharged after 28 days. This is the first report of a coronary artery perforation into the gastrointestinal cavity.

Keywords: coronary artery perforation; gastric ulceration; gastrointestinal bleeding.