Background: The most common complication of coronary artery perforation, a rare complication of percutaneous\ncoronary intervention (PCI), is hemopericardium with cardiac tamponade. However, localized extra-coronary bleeding\ncan lead to epicardial hematoma, which is a rare phenomenon. We report the case of an unusual delayed presentation\nof post-PCI hematoma with unrecognized guidewire perforation.\nCase presentation: A 70-year-old man with idiopathic thrombocytopenic purpura (ITP) and a history of coronary\nartery bypass grafting (CABG) underwent PCI. A bare metal stent was implanted in left main coronary artery (LMCA)\nafter balloon dilation. The procedure was performed without any complications, and the patient was discharged 5 days\nlater. However, the patient was unexpectedly admitted by ambulance with cardiogenic shock and new-onset chest\npain the next day. Echocardiography did not show any wall motion abnormalities, but a large mass on the right\nventricle outflow tract was detected. Contrast-enhanced computed tomography showed a hematoma compressing\nthe main pulmonary artery trunk and the right ventricle. The patient developed sudden cardiopulmonary arrest and\ncardiopulmonary resuscitation was successful. The patient died during emergent surgical removal of the hematoma.\nLarge, dark red clots between the pulmonary artery trunk and aorta were observed. The suspected origin of the\nepicardial hematoma was blood oozing from the stent site in LMCA.\nConclusion: This is an unusual case with delayed development of localized hematoma following PCI in the absence of\nguidewire perforation. Furthermore, this case illustrated the potential of occasional critical complications in patients\nwith impaired blood clotting undergoing PCI.
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