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Right coronary artery lesion is an uncommon and serious complication of typical atrial flutter ablation. We report a case of right coronary artery occlusion during atrial flutter ablation managed with percutaneous coronary intervention, combined with a review of the literature, in order to obtain pathogenetic and epidemiological information about this complication.

Percutaneous coronary intervention (PCI) has witnessed a period of remarkable advancements in the past decade. Such progress has promoted a pronounced expansion of the indication of PCI to what were previously considered untreatable lesions. This has particularly benefitted the field of chronic total occlusion (CTO). CTO operators often face challenging procedural scenarios, for which specific techniques have been developed. In this review, we will focus on and provide a detailed description of advanced percutaneous techniques aimed at solving a relatively rare complication of PCI of non-occlusive lesions, which is however associated with a large burden of morbidity and mortality: acute vessel closure due to coronary dissection.

We report the case of a chronic total occlusion in the left circumflex coronary artery due to the struts of a stent previously placed on the left main artery. The procedure was complicated by detachment of the stent advanced into the culprit lesion within the struts of the previously implanted stent in the left main artery. The extraction of the lost stent was performed using the twisting wire technique, but this operation resulted in a further complication, i.e. avulsion of the previously implanted stent on the left main artery. The case was resolved favorably with the implantation of a new stent on the left main artery and surgical extraction of the retracted stent from the brachial artery.