Fatal pericardial tamponade after Wallstent implantation for malignant superior vena cava syndrome.

Purpose: To report a rare, fatal complication of superior vena cava Wallstent implantation.
Case Report: A 59-year-old man presenting with superior vena cava syndrome caused by small-cell lung cancer underwent stent implantation of 2 kissing Wallstents >1.5 cm above the right atrium. Despite correct stent deployment, vessel perforation occurred in a section not encased by tumor, which led to fatal pericardial tamponade shortly after the procedure. Autopsy revealed perforation of a stent strut through the caval wall into the pericardial space. Anatomical and methodological reasons are discussed.
Conclusions: The interventionist should be aware of this rare complication. Alternative stent designs avoiding the sharp ends of Wallstents and Palmaz stents should be considered.