Tenting Sign on Intravascular Ultrasound: A Red Flag for Coronary Perforation Risk During Rotational Atherectomy.

Coronary perforation (CP) is a rare but one of the most serious complications of rotational atherectomy (RA). The presence of a "tenting sign" on intravascular ultrasound, which reflects outward deformation of the normal vessel wall due to extreme wire bias, may indicate an elevated risk of CP following RA. We report a case of CP in the left circumflex coronary artery that occurred at a site where the tenting sign was observed on IVUS before RA.