Underexpanded covered-stent

Coronary perforations are feared and potentially lethal complications in the cardiac laboratory. therapeutic strategies include prolonged balloon inflation, reversal of anticoagulation, embolization of the distal vessel and surgery. deployment of a covered stent is another therapeutic approach especially when the tear is large and involves proximal or mid coronary artery. due to the high profile and poor flexibility of polytetrafluoroethylene (ptfe) covered stents; it is often difficult to deliver them to the target site, especially when the vessel is heavily calcified and tortuous. although they can usually effectively seal the perforations, full expansion should be ensured as any other stent. however, in the chaotic milieu of these life-threatening complications, it can be overlooked. this case is a reminder of the importance of optimal expansion of the covered-stents.