Fig. 1.

A: angiography revealed 80% stenosis aggravated by severe muscular bridging at the mid LAD. B: at a nominal pressure of, the stent was not fully expanded in the middle segment of the lesion. So, we inflated the stent with a high pressure, up to 16 atm. C: on follow-up angiography, the coronary artery was perforated and extravasation of contrast into the pericardium was noted at the site of the lesion. D: an IVUS study showed the perforation site and a perivascular hematoma along the lesion. E: after implantation of a covered stent, leaking flow from the coronary lesion was no longer noted. F: follow-up echocardiography showed a minimal amount of pericardial effusion (arrow) without hemodynamic instability. LAD: left anterior descending, IVUS: intravascular ultrasound.