[Perforation of the vascular wall after coronary excimer laser angioplasty].

A 56-year-old patient with recurrent episodes of angina pectoris at rest was admitted for left-heart catheterization. The coronary angiogram revealed two-vessel disease with a subtotal stenosis in the circumflex artery and a long 90% stenosis in the proximal part of the left anterior descending artery. On the basis of symptoms and coronary morphology laser angioplasty was performed. After a total of 99 s of energy delivery extravasation of dye occurred at the site of ablation. Due to acute vessel occlusion subsequent PTCA was performed, resulting in a satisfactory angiographic result. Extravasation of dye was terminated after PTCA and was absent at short-term follow-up angiography. No signs of pericardial effusion were detectable by two-dimensional and M-mode echocardiography. A control angiogram disclosed the identical result the day after the acute intervention, and the patient could be discharged with a normal exercise test 1 week later.