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Stent thrombosis or Lead Perforation -- A clinical dilemma
  • Omar Shaikh,
  • berkay karahacioglu
Omar Shaikh
Royal Bournemouth Hospital

Corresponding Author:[email protected]

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berkay karahacioglu
Royal Papworth Hospital NHS Foundation Trust Transplant Services
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A 78-year-old male patient was brought via the Primary percutaneous coronary intervention (PPCI) service to our hospital for urgent angiography. He had been discharged a week ago, after presenting with chest pain and undergoing Primary Percutaneous intervention (PCI) to the Left Circumflex artery, followed by Permanent pacemaker insertion for treatment of Sick Sinus Syndrome. CT Coronary angiography/CT Chest demonstrated a right ventricular lead perforation, alongside an occlusion in the mid-distal segment of the recently inserted stent in the circumflex artery. The diagnosis required careful interpretation of the pacing check, and a high clinical suspicion of lead perforation. The perforated lead was removed, and a new lead positioned in the Right ventricular septum the following day. There was also an attempt to open the occluded circumflex artery, but this was unsuccessful.