{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:10:19Z","timestamp":1776777019987,"version":"3.51.2"},"reference-count":12,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Coronary perforations are infrequent but potentially fatal complications during percutaneous coronary intervention (PCI). Interventional management aims to stop extravasation and restore distal flow to prevent tamponade and cardiogenic shock. In current practice, the ping-pong technique is recommended to ensure sealing of the perforation during covered stent delivery. However, this method is complex, time-consuming, and requires a second vascular access. Therefore, we developed a technique that seals the perforation and enables covered stent implantation using a single guide catheter. Methods: This technical note describes a novel technique in which a guide extension catheter (GEC) can be advanced across a vascular perforation after balloon inflation. The insertion of the GEC is made possible by detachment of the balloon hypotube. To minimize leakage, a regular coronary wire introducer needle is attached to the snapped hypotube after GEC loading and continuously inflated to hold nominal pressure. Advancement of the GEC across the perforation immediately limits hemorrhage and facilitates covered stent deployment via a single vascular access. The technique was first evaluated in bench testing and subsequently applied in three illustrative clinical cases at a tertiary referral center using standard, commercially available devices. Results: Bench testing confirmed the reproducibility of the ripping maneuver and successful ballon inflation over enough time to advance the GEC with the introducer married with the ripped hypotube. In all clinical cases, the GEC was successfully advanced across the perforation, allowing prompt covered stent deployment where necessary using a single guide catheter and access site without technical failure. Conclusions: The RIP (Rip and Inflate in Perforations)\u2014technique is a feasible and reproducible alternative to the ping-pong technique. Bench validation and initial clinical application suggest that it may simplify the management of large-vessel perforations while reducing procedural complexity and the need for additional vascular access.<\/jats:p>","DOI":"10.3390\/jcm15083163","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:42:45Z","timestamp":1776771765000},"page":"3163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Percutaneous Technique for Coaxial Treatment of Large Coronary Vessel Perforations\u2014The RIP (Rip and Inflate in Perforations) Technique"],"prefix":"10.3390","volume":"15","author":[{"given":"Maximilian","family":"Will","sequence":"first","affiliation":[{"name":"Department of Internal Medicine 3, University Hospital St. P\u00f6lten\u2014NOE LGA, Karl Landsteiner University, Dunant-Platz 1, 3100 St. P\u00f6lten, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantin","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, University Hospital St. P\u00f6lten\u2014NOE LGA, Karl Landsteiner University, Dunant-Platz 1, 3100 St. P\u00f6lten, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregor","family":"Leibundgut","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie, Universit\u00e4tsspital Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1253\/circj.CJ-19-0757","article-title":"Coronary Artery Perforation and Tamponade: Incidence, Risk Factors, Predictors and Outcomes from 12 Years\u2019 Data of the SCAAR Registry","volume":"84","author":"Harnek","year":"2019","journal-title":"Circ. 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Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e003449","DOI":"10.1161\/CIRCINTERVENTIONS.115.003449","article-title":"Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013: An Analysis of 527,121 Cases from the British Cardiovascular Intervention Society Database","volume":"9","author":"Kinnaird","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_11","first-page":"584","article-title":"Covered Stent Implantation through a Single 8-French Guide Catheter for the Management of a Distal Coronary Perforation","volume":"90","author":"Sandoval","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_12","first-page":"1675","article-title":"First In-Human Use of a Novel Perfusion Balloon Catheter in the Management of Coronary Perforation","volume":"40","author":"Siu","year":"2024","journal-title":"Can. J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:25:14Z","timestamp":1776774314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":12,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15083163"],"URL":"https:\/\/doi.org\/10.3390\/jcm15083163","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}