Cardiovascular collapse post chronic total occlusion percutaneous coronary intervention due to a compressive left atrial hematoma managed with percutaneous drainage.

This case illustrates a potential complication of the retrograde approach using epicardial collaterals for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Hypotension post CTO PCI in a patient who has undergone previous cardiac surgery can have multiple causes, one of which is chamber compression from a localized hematoma due to coronary perforation as occurred in this case. This report is the first description of successful nonsurgical management of a left atrial hematoma causing cardiovascular collapse with percutaneous drainage.