{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:57:30Z","timestamp":1785776250503,"version":"3.56.0"},"reference-count":10,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Coronary artery perforation (CAP) is a rare but potentially life\u2010threatening complication of percutaneous coronary intervention, particularly during complex procedures such as rotational atherectomy. Ellis type III perforations are associated with high morbidity and mortality and usually require covered stent implantation or embolization techniques. We report the case of an 83\u2010year\u2010old man undergoing rotational atherectomy of a severely calcified left anterior descending artery. An Ellis type III coronary perforation occurred following abrupt burr exit at a curved mid\u2010LAD segment. Immediate and prolonged balloon tamponade was performed, and the ping\u2010pong technique was used to secure distal coronary access while maintaining continuous mechanical hemostasis. Partial heparin reversal with protamine was administered under sustained balloon inflation after exclusion of cardiac tamponade, using a half\u2010dose strategy as a temporary bridging measure. During distal rewiring, no further contrast extravasation was observed, and the guidewire crossed easily into the distal true lumen. This structured bailout strategy resulted in successful sealing of the perforation without cardiac tamponade, pericardiocentesis, or covered stent implantation. Final angiographic and clinical outcomes were favorable. A systematic follow\u2010up angiography performed at 3 weeks demonstrated an excellent result. At 8\u2010month follow\u2010up, the patient remained asymptomatic with normalization of left ventricular function and sustained clinical stability. This case illustrates a rare mechanism of coronary perforation related to burr exit during rotational atherectomy and highlights a structured bailout strategy combining prolonged balloon tamponade, the ping\u2010pong technique, and controlled partial anticoagulation reversal. This approach may allow safe stabilization and facilitate definitive management in selected cases, without challenging the established role of covered stent implantation in major coronary perforations.<\/jats:p>","DOI":"10.1002\/ccd.70671","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:20:19Z","timestamp":1779942019000},"page":"468-472","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Perforation Caused by Burr Exit During Rotational Atherectomy Successfully Managed With the Ping\u2010Pong Balloon Technique Without Covered Stent Implantation"],"prefix":"10.1002","volume":"108","author":[{"given":"Kais","family":"Ouerghi","sequence":"first","affiliation":[{"name":"Department of Cardiology Centre Hospitalier de Laval Laval France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahar","family":"Lazizi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Centre Hospitalier de Laval Laval France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Mateus","sequence":"additional","affiliation":[{"name":"Department of Cardiology Centre Hospitalier de Laval Laval France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.6.2725"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810320303"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.08.026"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1065"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.07.048"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.09.042"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.07.017"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.12.196"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.31339"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.25.3028"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70671","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70671","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:33:31Z","timestamp":1785774811000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ccd.70671"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70671","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]},"assertion":[{"value":"2026-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}