Coronary artery perforation by cutting balloon resulting in dissecting subepicardial hematoma and avulsion of the vasculature.

We report a case of perforation caused by cutting balloon angioplasty of in-stent restenosis in a saphenous vein coronary bypass graft. This was complicated by a subepicardial hematoma leading to avulsion of the penetrating arteries and cardiogenic shock. Despite surgical evacuation and percutaneous left ventricular assist-device support, death ensued.